Many studies using diffusion tensor tractography（DTT） have demonstrated that injury of the spinothalamic tract（STT） is the pathogenetic mechanism of central post-stroke pain（CPSP） in intracerebral hemorrhage; ho...Many studies using diffusion tensor tractography（DTT） have demonstrated that injury of the spinothalamic tract（STT） is the pathogenetic mechanism of central post-stroke pain（CPSP） in intracerebral hemorrhage; however, there is no DTT study reporting the pathogenetic mechanism of CPSP in cerebral infarction. In this study, we investigated injury of the STT in patients with CPSP following cerebral infarction, using DTT. Five patients with CPSP following cerebral infarction and eight age-and sex-matched healthy control subjects were recruited for this study. STT was examined using DTT. Among DTT parameters of the affected STT, fractional anisotropy and tract volume were decreased by more than two standard deviations in two patients（patients 1 and 2） and three patients（patients 3, 4, and 5）, respectively, compared with those of the control subjects, while mean diffusivity value was increased by more than two standard deviations in one patient（patient 2）. Regarding DTT configuration, all affected STTs passed through adjacent part of the infarct and three STTs showed narrowing. These findings suggest that injury of the STT might be a pathogenetic etiology of CPSP in patients with cerebral infarction.展开更多
Central post-stroke pain(CPSP), which is neuropathic pain associated with a brain lesion following a stroke, was first described by Dejerine and Roussy in 1906 in a thalamic infarct patient(Dejerine and Roussy, 1906;W...Central post-stroke pain(CPSP), which is neuropathic pain associated with a brain lesion following a stroke, was first described by Dejerine and Roussy in 1906 in a thalamic infarct patient(Dejerine and Roussy, 1906;Watson and Sandroni, 2016).展开更多
Intractable central post-stroke pain（CPSP） is one of the most common sequelae of stroke, but has been inadequately studied to date. In this study, we first determined the relationship between the lesion site and cha...Intractable central post-stroke pain（CPSP） is one of the most common sequelae of stroke, but has been inadequately studied to date. In this study, we first determined the relationship between the lesion site and changes in mechanical or thermal pain sensitivity in a rat CPSP model with experimental thalamic hemorrhage produced by unilateral intra-thalamic collagenase IV（ITC） injection. Then, we evaluated the efficacy of gabapentin（GBP）, an anticonvulsant that binds the voltage-gated Ca2＋ channel α2δ and a commonly used anti-neuropathic pain medication. Histological case-by-case analysis showed that only lesions confined to the medial lemniscus and the ventroposterior lateral/medial nuclei of the thalamus and/or the posterior thalamic nucleus resulted in bilateral mechanical pain hypersensitivity. All of the animals displaying CPSP also had impaired motor coordination, while control rats with intra-thalamic saline developed no central pain or motor deficits. GBP had a dose-related anti-allodynic effect after a single administration（1, 10, or 100 mg/kg） on day 7 post-ITC, with significant effects lasting at least 5 hfor the higher doses. However, repeated treatment, once a day for two weeks, resulted in complete loss of effectiveness（drug tolerance） at 10 mg/kg, while effectiveness remained at 100 mg/kg, although the time period of efficacious analgesia was reduced. In addition, GBP did not change the basal pain sensitivity and the motor impairment caused by the ITC lesion, suggesting selective action of GBP on the somatosensory system.展开更多
The α2δ-1 subunit of the voltage-gated Ca2＋ channel （VGCC） is a molecular target of gabapentin （GBP）, which has been used as a first-line drug for the relief of neuropathic pain. GBP exerts its anti-nociceptive...The α2δ-1 subunit of the voltage-gated Ca2＋ channel （VGCC） is a molecular target of gabapentin （GBP）, which has been used as a first-line drug for the relief of neuropathic pain. GBP exerts its anti-nociceptive effects by disrupting trafficking of the α2δ-1 subunit to the presynaptic membrane, resulting in decreased neurotrans- mitter release. We previously showed that GBP has an anti- allodynic effect in the first two weeks; but this is followed by insensitivity in the later stage after repeated adminis- tration in a rat model of central post-stroke pain （CPSP） hypersensitivity induced by intra-thalamic hemorrhage. To explore the mechanisms underlying GBP insensitivity, the cellular localization and time-course of expression of the α2δ-1 subunit in both the thalamus and spinal dorsal horn were studied in the same model. We found that the α2δ-1 subunit was mostly localized in neurons, but not astrocytes and microglia. The level of α2δ-1 protein increased in the first two weeks after injury but then decreased in the third week, when GBP insensitivity occurred. Furthermore, the c^2g-1 down-regulation was likely caused by later neuronal loss in the injured thalamus through a mechanism other than apoptosis. In summary, the present results suggest that the GBP receptor ~2^-1 is mainly expressed in thalamic neurons in which it is up-regulated in the early stage of CPSP but this is followed by dramatic down-regulation, which is likely associated with GBP insensitivity after long-term use.展开更多
BACKGROUND Post-stroke epilepsy is a common and easily overlooked complication of acute cerebrovascular disease.Long-term seizures can seriously affect the prognosis and quality of life of patients.Electroencephalogra...BACKGROUND Post-stroke epilepsy is a common and easily overlooked complication of acute cerebrovascular disease.Long-term seizures can seriously affect the prognosis and quality of life of patients.Electroencephalogram(EEG)is the simplest way to diagnose epilepsy,and plays an important role in predicting seizures and guiding medication.AIM To explore the EEG characteristics of patients with post-stroke epilepsy and improve the detection rate of inter-seizure epileptiform discharges.METHODS From January 2017 to June 2020,10 patients with post-stroke epilepsy in our hospital were included.The clinical,imaging,and EEG characteristics were collected.The stroke location,seizure type,and ictal and interictal EEG manifestations of the patients with post-stroke epilepsy were then retrospectively analyzed.RESULTS In all 10 patients,epileptiform waves occurred in the side opposite to the stroke lesion during the interictal stage;these manifested as sharp wave,sharp-wave complex,or spike discharges in the anterior head lead of the side opposite to the lesion.CONCLUSION In EEG,epileptiform waves can occur in the side opposite to the stroke lesion in patients with post-stroke epilepsy.展开更多
Background:To investigate the effects of acupuncture on post-stroke limb spasm model rats and the underlying mechanism.Methods:A total of 50 Sprague-Dawley rats were randomly divided into three groups,Control group(10...Background:To investigate the effects of acupuncture on post-stroke limb spasm model rats and the underlying mechanism.Methods:A total of 50 Sprague-Dawley rats were randomly divided into three groups,Control group(10),Model group(20)and Zhishen Tiaoxing(ZSTX)acupuncture group(20).Middle cerebral artery occlusion was conducted in SD rats to establish post-stroke limb spasm rats,which were treated with ZSTX acupuncture.Behavioral assays were determined by the Narrow ally test,the limb muscle tension was detected by the BL-420S test system,and infarct volume was assessed after the cerebral infarction by 2,3,5-triphenyltetrazolium chloride staining.Heterogeneous neurotransmitterγ-aminobutyric acid(GABA)and its receptors GABAA and GABAB in the cerebral cortex of the infarct area were determined by immunofluorescence assay.The release of Trkb and K-Cl cotransporter isoform 2 was detected by an immunofluorescence double labeling study.Western Blot was utilized to measure the expression of BDNF and Trkb.Results:The results showed that the behavioral assays in post-stroke limb spasm rats were significantly improved by the treatment of ZSTX acupuncture.14 days of ZSTX acupuncture can effectively inhibit muscle tone and decrease Infarct volume,which was measured with BL-420S biological function experiment system and triphenyltetrazolium chloride.Meanwhile,the results of Double-Label Immunofluorescence Assays showed that ZSTX acupuncture improved the expression of GABA,GABAA,GABAB,BDNF,and K-Cl cotransporter isoform 2.Double-Label Immunofluorescence Assays and WB results showed that 14 days ZSTX acupuncture declined the expression of Trkb.Conclusions:Our results suggest that 14 days of ZSTX acupuncture can significantly improve post-stroke limb spasm.Meanwhile,the pathogenesis of post-stroke limb spasm and the efficacy of ZSTX acupuncture involve metabolic pathways of neurotransmitters,and electro-acupuncture can treat post-stroke limb spasm by regulating BDNF/Trkb-KCC2 signaling pathway.展开更多
BACKGROUND Post-stroke depression(PSD)is a common and debilitating condition affecting stroke survivors,significantly impacting their recovery and overall quality of life.AIM To assess the effects of early PSD screeni...BACKGROUND Post-stroke depression(PSD)is a common and debilitating condition affecting stroke survivors,significantly impacting their recovery and overall quality of life.AIM To assess the effects of early PSD screening on functional outcomes,quality of life,and mortality.METHODS From an initial pool of 1065 articles,6 studies met the inclusion criteria and were selected for analysis.Functional outcomes were measured using the functional independence measure(FIM).RESULTS The analysis revealed a significant improvement in FIM scores for a PSD scree-ning group compared to controls[standardized mean difference(SMD)=8.90,95%confidence interval(CI):4.65-13.15,P<0.01].Quality of life was assessed using the Stroke-Specific Quality of Life Scale,with the screening group showing significantly higher scores(SMD=20.83,95%CI:15.27-26.38,P<0.01).Mortality analysis indicated a reduction in five-year mortality rates for the PSD screening group.CONCLUSION Early PSD screening enhances functional recovery,improves quality of life,and reduces mortality rates in stroke survivors.Thus,integrating PSD screening into routine stroke care improves long-term outcomes for patients.展开更多
Medical procedures are inherently invasive and carry the risk of inducing pain to the mind and body.Recently,efforts have been made to alleviate the discomfort associated with invasive medical procedures through the u...Medical procedures are inherently invasive and carry the risk of inducing pain to the mind and body.Recently,efforts have been made to alleviate the discomfort associated with invasive medical procedures through the use of virtual reality(VR)technology.VR has been demonstrated to be an effective treatment for pain associated with medical procedures,as well as for chronic pain conditions for which no effective treatment has been established.The precise mechanism by which the diversion from reality facilitated by VR contributes to the diminution of pain and anxiety has yet to be elucidated.However,the provision of positive images through VR-based visual stimulation may enhance the functionality of brain networks.The salience network is diminished,while the default mode network is enhanced.Additionally,the medial prefrontal cortex may establish a stronger connection with the default mode network,which could result in a reduction of pain and anxiety.Further research into the potential of VR technology to alleviate pain could lead to a reduction in the number of individuals who overdose on painkillers and contribute to positive change in the medical field.展开更多
Objective: This study compares the cardiorespiratory fitness of stroke patients with that of healthy control subjects matched by age and gender. It was a descriptive, analytical and comparative case-control study that...Objective: This study compares the cardiorespiratory fitness of stroke patients with that of healthy control subjects matched by age and gender. It was a descriptive, analytical and comparative case-control study that aims to assess the aerobic capacity of stroke survivors in Cotonou. Methods: Data were collected during the Six-Minute Walk Test from 91 patients affected by stroke at least (03) three months ago and from 91 healthy subjects, who are at least 18 years old. Results: The average age was 53.16 ± 10.13 years with a sex ratio equal to 2.5. 45.05% of patients had ischemic strokes and 31.87% had strokes of unspecified origin. 59.34% of patients were right side affected, and almost all had a low level of physical activity. The average distance covered in relation to VO2 max was 276.39 ± 175.27 meters with an estimated VO2 max of 11.3 ± 4.03 ml/min/kg in patients and 464.14 ± 128.4 meters for an estimated VO2 max of 15.62 ± 8.72 ml/min/kg. These values were highly significantly influenced by age, post-stroke duration and level of exercise. Conclusion: The study revealed a low cardiorespiratory fitness in the study population, and suggests that post-stroke patients should be monitored by improving their aerobic endurance through an adapted physical activity program aimed at preventing recurrence.展开更多
In this article, we present our previous research, which highlighted adenosine triphosphate(ATP) as the cause of neuropathic pain during the acute phase of neuromyelitis optica spectrum disorder(NMOSD). In NMOSD patho...In this article, we present our previous research, which highlighted adenosine triphosphate(ATP) as the cause of neuropathic pain during the acute phase of neuromyelitis optica spectrum disorder(NMOSD). In NMOSD pathology, damageassociated molecular patterns(DAMPs), including ATP, are released from damaged astrocytes, triggering the activation of innate immune cells. ATP is a central mediator of acute pain in NMOSD.展开更多
Vulvodynia,a chronic pain disorder affecting the vulvar region,represents a significant challenge in both diagnosis and treatment within the field of women’s health.This condition is characterized by chronic pain tha...Vulvodynia,a chronic pain disorder affecting the vulvar region,represents a significant challenge in both diagnosis and treatment within the field of women’s health.This condition is characterized by chronic pain that significantly affects the quality of life of afflicted women.The present perspective paper examines the role of spinal sensitization and microglial activation in vulvodynia.展开更多
In this editorial,we comment on a recent article by Chen et al,that addressed the effect of intraoperative injection of esketamine on postoperative analgesia and postoperative rehabilitation after cesarean section.Poo...In this editorial,we comment on a recent article by Chen et al,that addressed the effect of intraoperative injection of esketamine on postoperative analgesia and postoperative rehabilitation after cesarean section.Poor management of postcesarean pain is associated with decreased maternal care for the baby,longer hospitalization,and higher risk of developing postpartum depression.Esketamine is a more potent S-enantiomer of ketamine which has shown promising analgesic and antidepressant properties for managing post-cesarean pain and depression in clinical studies.However,due to its potential adverse effects on the neurological and hemodynamic status of patients,it is recommended that its usage in low doses should be limited to cesarean candidates experiencing unbearable pain.Before any recommendation for routine perioperative use of esketamine,more standardized clinical trials are needed to strengthen our existing knowledge of its effectiveness in reducing postpartum pain and depression.展开更多
Objective Magnetoencephalography(MEG),a non-invasive neuroimaging technique,meticulously captures the magnetic fields emanating from brain electrical activity.Compared with MEG based on superconducting quantum interfe...Objective Magnetoencephalography(MEG),a non-invasive neuroimaging technique,meticulously captures the magnetic fields emanating from brain electrical activity.Compared with MEG based on superconducting quantum interference devices(SQUID),MEG based on optically pump magnetometer(OPM)has the advantages of higher sensitivity,better spatial resolution and lower cost.However,most of the current studies are clinical studies,and there is a lack of animal studies on MEG based on OPM technology.Pain,a multifaceted sensory and emotional phenomenon,induces intricate alterations in brain activity,exhibiting notable sex differences.Despite clinical revelations of pain-related neuronal activity through MEG,specific properties remain elusive,and comprehensive laboratory studies on pain-associated brain activity alterations are lacking.The aim of this study was to investigate the effects of inflammatory pain(induced by Complete Freund’s Adjuvant(CFA))on brain activity in a rat model using the MEG technique,to analysis changes in brain activity during pain perception,and to explore sex differences in pain-related MEG signaling.Methods This study utilized adult male and female Sprague-Dawley rats.Inflammatory pain was induced via intraplantar injection of CFA(100μl,50%in saline)in the left hind paw,with control groups receiving saline.Pain behavior was assessed using von Frey filaments at baseline and 1 h post-injection.For MEG recording,anesthetized rats had an OPM positioned on their head within a magnetic shield,undergoing two 15-minute sessions:a 5-minute baseline followed by a 10-minute mechanical stimulation phase.Data analysis included artifact removal and time-frequency analysis of spontaneous brain activity using accumulated spectrograms,generating spectrograms focused on the 4-30 Hz frequency range.Results MEG recordings in anesthetized rats during resting states and hind paw mechanical stimulation were compared,before and after saline/CFA injections.Mechanical stimulation elevated alpha activity in both male and female rats pre-and post-saline/CFA injections.Saline/CFA injections augmented average power in both sexes compared to pre-injection states.Remarkably,female rats exhibited higher average spectral power 1 h after CFA injection than after saline injection during resting states.Furthermore,despite comparable pain thresholds measured by classical pain behavioral tests post-CFA treatment,female rats displayed higher average power than males in the resting state after CFA injection.Conclusion These results imply an enhanced perception of inflammatory pain in female rats compared to their male counterparts.Our study exhibits sex differences in alpha activities following CFA injection,highlighting heightened brain alpha activity in female rats during acute inflammatory pain in the resting state.Our study provides a method for OPM-based MEG recordings to be used to study brain activity in anaesthetized animals.In addition,the findings of this study contribute to a deeper understanding of pain-related neural activity and pain sex differences.展开更多
Pain is often comorbid with emotional disorders such as anxiety and depression.Hyperexcitability of the anterior cingulate cortex has been implicated in pain and pain-related negative emotions that arise from impairme...Pain is often comorbid with emotional disorders such as anxiety and depression.Hyperexcitability of the anterior cingulate cortex has been implicated in pain and pain-related negative emotions that arise from impairments in inhibitory gamma-aminobutyric acid neurotransmission.This review primarily aims to outline the main circuitry(including the input and output connectivity)of the anterior cingulate cortex and classification and functions of different gamma-aminobutyric acidergic neurons;it also describes the neurotransmitters/neuromodulators affecting these neurons,their intercommunication with other neurons,and their importance in mental comorbidities associated with chronic pain disorders.Improving understanding on their role in pain-related mental comorbidities may facilitate the development of more effective treatments for these conditions.However,the mechanisms that regulate gamma-aminobutyric acidergic systems remain elusive.It is also unclear as to whether the mechanisms are presynaptic or postsynaptic.Further exploration of the complexities of this system may reveal new pathways for research and drug development.展开更多
Protein arginine methyltransferase-6 participates in a range of biological functions,particularly RNA processing,transcription,chromatin remodeling,and endosomal trafficking.However,it remains unclear whether protein ...Protein arginine methyltransferase-6 participates in a range of biological functions,particularly RNA processing,transcription,chromatin remodeling,and endosomal trafficking.However,it remains unclear whether protein arginine methyl transferase-6 modifies neuropathic pain and,if so,what the mechanisms of this effect.In this study,protein arginine methyltransferase-6 expression levels and its effect on neuropathic pain were investigated in the spared nerve injury model,chronic constriction injury model and bone cancer pain model,using immunohistochemistry,western blotting,immunoprecipitation,and label-free proteomic analysis.The results showed that protein arginine methyltransferase-6 mostly co-localized withβ-tubulinⅢin the dorsal root ganglion,and that its expression decreased following spared nerve injury,chronic constriction injury and bone cancer pain.In addition,PRMT6 knockout(Prmt6~(-/-))mice exhibited pain hypersensitivity.Furthermore,the development of spared nerve injury-induced hypersensitivity to mechanical pain was attenuated by blocking the decrease in protein arginine methyltransferase-6 expression.Moreover,when protein arginine methyltransferase-6 expression was downregulated in the dorsal root ganglion in mice without spared nerve injury,increased levels of phosphorylated extracellular signal-regulated kinases were observed in the ipsilateral dorsal horn,and the response to mechanical stimuli was enhanced.Mechanistically,protein arginine methyltransferase-6 appeared to contribute to spared nerve injury-induced neuropathic pain by regulating the expression of heterogeneous nuclear ribonucleoprotein-F.Additionally,protein arginine methyltransfe rase-6-mediated modulation of hete rogeneous nuclear ribonucleoprotein-F expression required amino atids 319 to 388,but not classical H3R2 methylation.These findings indicated that protein arginine methyltransferase-6 is a potential therapeutic target fo r the treatment of peripheral neuro pathic pain.展开更多
Objectives: This study aimed to evaluate the prolonged therapeutic effects of a 35 kDa molecular weight hyaluronan fragment (HA35) in alleviating pain associated with myofascial pain syndrome (MPS). Hyaluronan interac...Objectives: This study aimed to evaluate the prolonged therapeutic effects of a 35 kDa molecular weight hyaluronan fragment (HA35) in alleviating pain associated with myofascial pain syndrome (MPS). Hyaluronan interacts with various receptors in the human body, including CD44, LYVE-1, RHAMM, and TLR2, and is well-known for its analgesic effects when used in intra-articular or ultrasound-guided nerve trunk injections. Studies have shown that hyaluronidase cleaves high molecular weight HA to generate HA35, a low molecular weight fragment with enhanced tissue permeability, capable of binding to HA receptors on cell surfaces to produce broad-spectrum analgesic effects. Methods: Ten patients diagnosed with MPS were treated and assessed in this study. HA35 was administered through injection at a dosage of 100 mg daily for 15 days. Patients evaluated their MPS, overall pain levels, and treatment satisfaction using the Numerical Pain Rating Scale (NPRS), the Global Pain Scale (GPS), and the Treatment Satisfaction Questionnaire for Medication (TSQM 1.4). Follow-up evaluations were performed three months post-treatment to assess the duration of therapeutic effects. Results: Significant improvements were observed in NPRS, GPS, and TSQM scores both during and after the treatment period (P Conclusions: HA35 provides effective and sustained relief from pain associated with MPS, demonstrating a prolonged therapeutic benefit.展开更多
BACKGROUND Abdominal aortic aneurysm(AAA)repair often involves significant postoperative pain,traditionally managed with systemic opioids,which can cause undesirable side effects.This case report explores the novel us...BACKGROUND Abdominal aortic aneurysm(AAA)repair often involves significant postoperative pain,traditionally managed with systemic opioids,which can cause undesirable side effects.This case report explores the novel use of a surgically-initiated rectus sheath block with a catheter-over-needle assembly for pain management in AAA repair.CASE SUMMARY A 67-year-old female with hypertension and previous aortic dissection underwent elective open repair of an infrarenal AAA,which had grown from 3.4 cm to 4.3 cm over 14 months.A rectus sheath block was initiated surgically for postoperative pain control.The patient reported low pain scores and did not require systemic intravenous opioids,enabling early ambulation and discharge on postoperative day seven without complications.By preventing complications of systemic opi-oids,the method indicating a promising direction for postoperative pain management in major vascular surgeries.CONCLUSION Surgically-initiated rectus sheath block as a valuable tool for managing postoperative pain in AAA repair.展开更多
Postoperative pain is an acute pain that appears due to the surgical act, reaching its maximum intensity in the first 24 - 48 hours after surgery. Postoperative pain control reduces possible postoperative complication...Postoperative pain is an acute pain that appears due to the surgical act, reaching its maximum intensity in the first 24 - 48 hours after surgery. Postoperative pain control reduces possible postoperative complications, as well as the patient’s stay in the medical institution. Objective: This study compared the effectiveness and side effects of oral transmucosal fentanyl citrate (OTFC) with IV morphine in the control of postoperative pain. Methods: Seventy-three patients (Fentanyl group: 27, morphine group: 46) were included. Changes in pain were evaluated with Visual Analog Scale (VAS) and Pain Relief Scale, Pain Intensity Differences (PID), Sum of Pain Intensity Differences (SPID), and Total Pain Relief (TOTPAR). At time zero, 15, 30, 45 min and 1, 2, 3, 4, 5 and 6 h. Results: The decrease in pain intensity measured by VAS was similar in both groups with no significant differences at any of the measurement points. Both products produced a significant increase in the Pain Relief scale, with no differences between groups at any of the measurement times. There were no differences between groups when comparing PID. Comparing SPID between groups, there were no differences at 15, 30 minutes, then there were significant differences in favor of the Fentanyl group up to 6 hours. Both products produced a significant increase in the TOPAR scale, with no differences between groups at any of the measurement times. The appearance of adverse effects was similar in both groups. Conclusions: Both products produced a significant reduction in the measures of pain intensity (VAS), increase of SPID, as well as a significant increase in the Pain Relief scale, a significant increase in the TOPAR scale, with no differences between the groups. The number of adverse effects was similar. The convenience of OTFC administration allows its administration without the special conditions needed for the administration of IV morphine.展开更多
Introduction: Pain has been defined for more than 20 years by the International Association for the Study of Pain (IASP) as an unpleasant sensory and emotional experience associated with actual or potential tissue dam...Introduction: Pain has been defined for more than 20 years by the International Association for the Study of Pain (IASP) as an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage. It has been recognized as a feature of Parkinson’s disease (PD) since the first descriptions of the disease. Material and Methods: This was a prospective descriptive study lasting six (06) months from November 1, 2023 to April 30, 2024. We included all patients diagnosed with PD and who had pain. Sociodemographic, clinical, paraclinical and therapeutic data were evaluated for each patient. Results: We identified a sample of 62 Parkinson’s patients, of whom 52 patients or 85.2% had associated pain. We noted a male predominance (38M/14F) and a sex ratio of 2.71. Musculoskeletal pain was common in 80% of our respondents. WHO level I, antidepressants and background treatment for KD were the most prescribed molecules. Conclusion: Our study shows a frequency of pain in PD. However, musculoskeletal pain is the most frequently encountered type of pain in PD patients. WHO step I analgesics, antidepressants and background treatment of KD were the main prescriptions in our study.展开更多
Background: Osteopathic manual treatment (OMT) has been reported to have positive initial results for subjects with chronic non-specific back pain in a rural safety-net hospital. However, the effects of OMT following ...Background: Osteopathic manual treatment (OMT) has been reported to have positive initial results for subjects with chronic non-specific back pain in a rural safety-net hospital. However, the effects of OMT following initial treatment have not been reported. Objective: To determine the effects of OMT for patients with chronic non-specific back pain in a rural safety-net hospital setting for an initial post-clinical and follow-up visit. Methods: A longitudinal, rolling admission, eleven-year study of cohort study with a primary complaint of chronic, non-specific back pain that had plateaued in improvement for a minimum of six months. One hundred and fifty-one subjects completed the first two study visits necessary for data collection, and fifty-nine subjects completed the follow-up visit after six months. Results: A two-way, mixed model, repeated measures ANOVA with pre- post1 and post2 (follow-up) treatment as the within variable and sex as the between subject variable showed a significant main effect from pre- to follow-up, (F (1, 57) = 21.171, P ηP2= 0.426), but not a significant interaction between time and sex (F (1, 57) = 0.279, P ηP2= 0.002). Conclusions: The results of this study support the hypothesis that OMT has a continued benefit in pain reduction and functional improvement beyond the initial treatment period. The rural, safety-net hospital setting made this study unique relative to the sample population.展开更多
基金supported by the National Research Foundation(NRF)of Korea Grant funded by the Korean Government(MSIP),No.NRF-2015R1D1A1A01060314
文摘Many studies using diffusion tensor tractography（DTT） have demonstrated that injury of the spinothalamic tract（STT） is the pathogenetic mechanism of central post-stroke pain（CPSP） in intracerebral hemorrhage; however, there is no DTT study reporting the pathogenetic mechanism of CPSP in cerebral infarction. In this study, we investigated injury of the STT in patients with CPSP following cerebral infarction, using DTT. Five patients with CPSP following cerebral infarction and eight age-and sex-matched healthy control subjects were recruited for this study. STT was examined using DTT. Among DTT parameters of the affected STT, fractional anisotropy and tract volume were decreased by more than two standard deviations in two patients（patients 1 and 2） and three patients（patients 3, 4, and 5）, respectively, compared with those of the control subjects, while mean diffusivity value was increased by more than two standard deviations in one patient（patient 2）. Regarding DTT configuration, all affected STTs passed through adjacent part of the infarct and three STTs showed narrowing. These findings suggest that injury of the STT might be a pathogenetic etiology of CPSP in patients with cerebral infarction.
基金supported by a grant from Eulji University in 2019 (to HGK)。
文摘Central post-stroke pain(CPSP), which is neuropathic pain associated with a brain lesion following a stroke, was first described by Dejerine and Roussy in 1906 in a thalamic infarct patient(Dejerine and Roussy, 1906;Watson and Sandroni, 2016).
基金supported by grants from the National Natural Science Foundation of China (81171049)the National Basic Research Development Program of China (2011CB504100,2013CB835100 and 2013BAI04B04)
文摘Intractable central post-stroke pain（CPSP） is one of the most common sequelae of stroke, but has been inadequately studied to date. In this study, we first determined the relationship between the lesion site and changes in mechanical or thermal pain sensitivity in a rat CPSP model with experimental thalamic hemorrhage produced by unilateral intra-thalamic collagenase IV（ITC） injection. Then, we evaluated the efficacy of gabapentin（GBP）, an anticonvulsant that binds the voltage-gated Ca2＋ channel α2δ and a commonly used anti-neuropathic pain medication. Histological case-by-case analysis showed that only lesions confined to the medial lemniscus and the ventroposterior lateral/medial nuclei of the thalamus and/or the posterior thalamic nucleus resulted in bilateral mechanical pain hypersensitivity. All of the animals displaying CPSP also had impaired motor coordination, while control rats with intra-thalamic saline developed no central pain or motor deficits. GBP had a dose-related anti-allodynic effect after a single administration（1, 10, or 100 mg/kg） on day 7 post-ITC, with significant effects lasting at least 5 hfor the higher doses. However, repeated treatment, once a day for two weeks, resulted in complete loss of effectiveness（drug tolerance） at 10 mg/kg, while effectiveness remained at 100 mg/kg, although the time period of efficacious analgesia was reduced. In addition, GBP did not change the basal pain sensitivity and the motor impairment caused by the ITC lesion, suggesting selective action of GBP on the somatosensory system.
基金supported by the National Natural Science Foundation of China(81171049)the National Basic Research Development Program of China(2011CB504100 and2013CB835100)+1 种基金the National Key Technology R&D Program of China(2013BAI04B04)the Twelfth Five-Year Project of China(AWS12J004)
文摘The α2δ-1 subunit of the voltage-gated Ca2＋ channel （VGCC） is a molecular target of gabapentin （GBP）, which has been used as a first-line drug for the relief of neuropathic pain. GBP exerts its anti-nociceptive effects by disrupting trafficking of the α2δ-1 subunit to the presynaptic membrane, resulting in decreased neurotrans- mitter release. We previously showed that GBP has an anti- allodynic effect in the first two weeks; but this is followed by insensitivity in the later stage after repeated adminis- tration in a rat model of central post-stroke pain （CPSP） hypersensitivity induced by intra-thalamic hemorrhage. To explore the mechanisms underlying GBP insensitivity, the cellular localization and time-course of expression of the α2δ-1 subunit in both the thalamus and spinal dorsal horn were studied in the same model. We found that the α2δ-1 subunit was mostly localized in neurons, but not astrocytes and microglia. The level of α2δ-1 protein increased in the first two weeks after injury but then decreased in the third week, when GBP insensitivity occurred. Furthermore, the c^2g-1 down-regulation was likely caused by later neuronal loss in the injured thalamus through a mechanism other than apoptosis. In summary, the present results suggest that the GBP receptor ~2^-1 is mainly expressed in thalamic neurons in which it is up-regulated in the early stage of CPSP but this is followed by dramatic down-regulation, which is likely associated with GBP insensitivity after long-term use.
基金Research Fund for Lin He’s Academician Workstation of New Medicine and Clinical Translation in Jining Medical University,No.JYHL2019FMS25and The Key Research and Development Program of Jining,No.2022YXNS028.
文摘BACKGROUND Post-stroke epilepsy is a common and easily overlooked complication of acute cerebrovascular disease.Long-term seizures can seriously affect the prognosis and quality of life of patients.Electroencephalogram(EEG)is the simplest way to diagnose epilepsy,and plays an important role in predicting seizures and guiding medication.AIM To explore the EEG characteristics of patients with post-stroke epilepsy and improve the detection rate of inter-seizure epileptiform discharges.METHODS From January 2017 to June 2020,10 patients with post-stroke epilepsy in our hospital were included.The clinical,imaging,and EEG characteristics were collected.The stroke location,seizure type,and ictal and interictal EEG manifestations of the patients with post-stroke epilepsy were then retrospectively analyzed.RESULTS In all 10 patients,epileptiform waves occurred in the side opposite to the stroke lesion during the interictal stage;these manifested as sharp wave,sharp-wave complex,or spike discharges in the anterior head lead of the side opposite to the lesion.CONCLUSION In EEG,epileptiform waves can occur in the side opposite to the stroke lesion in patients with post-stroke epilepsy.
基金the National Key R&D Program of China(Grant No.2019YFC1709900)National Natural Science Foundation of China(Grant No.71804022)+1 种基金Natural Science Foundation of Henan province(Grant No.232300420256)Medical technologies R&D Program of Henan province(Grant No.LHGJ20220348).
文摘Background:To investigate the effects of acupuncture on post-stroke limb spasm model rats and the underlying mechanism.Methods:A total of 50 Sprague-Dawley rats were randomly divided into three groups,Control group(10),Model group(20)and Zhishen Tiaoxing(ZSTX)acupuncture group(20).Middle cerebral artery occlusion was conducted in SD rats to establish post-stroke limb spasm rats,which were treated with ZSTX acupuncture.Behavioral assays were determined by the Narrow ally test,the limb muscle tension was detected by the BL-420S test system,and infarct volume was assessed after the cerebral infarction by 2,3,5-triphenyltetrazolium chloride staining.Heterogeneous neurotransmitterγ-aminobutyric acid(GABA)and its receptors GABAA and GABAB in the cerebral cortex of the infarct area were determined by immunofluorescence assay.The release of Trkb and K-Cl cotransporter isoform 2 was detected by an immunofluorescence double labeling study.Western Blot was utilized to measure the expression of BDNF and Trkb.Results:The results showed that the behavioral assays in post-stroke limb spasm rats were significantly improved by the treatment of ZSTX acupuncture.14 days of ZSTX acupuncture can effectively inhibit muscle tone and decrease Infarct volume,which was measured with BL-420S biological function experiment system and triphenyltetrazolium chloride.Meanwhile,the results of Double-Label Immunofluorescence Assays showed that ZSTX acupuncture improved the expression of GABA,GABAA,GABAB,BDNF,and K-Cl cotransporter isoform 2.Double-Label Immunofluorescence Assays and WB results showed that 14 days ZSTX acupuncture declined the expression of Trkb.Conclusions:Our results suggest that 14 days of ZSTX acupuncture can significantly improve post-stroke limb spasm.Meanwhile,the pathogenesis of post-stroke limb spasm and the efficacy of ZSTX acupuncture involve metabolic pathways of neurotransmitters,and electro-acupuncture can treat post-stroke limb spasm by regulating BDNF/Trkb-KCC2 signaling pathway.
文摘BACKGROUND Post-stroke depression(PSD)is a common and debilitating condition affecting stroke survivors,significantly impacting their recovery and overall quality of life.AIM To assess the effects of early PSD screening on functional outcomes,quality of life,and mortality.METHODS From an initial pool of 1065 articles,6 studies met the inclusion criteria and were selected for analysis.Functional outcomes were measured using the functional independence measure(FIM).RESULTS The analysis revealed a significant improvement in FIM scores for a PSD scree-ning group compared to controls[standardized mean difference(SMD)=8.90,95%confidence interval(CI):4.65-13.15,P<0.01].Quality of life was assessed using the Stroke-Specific Quality of Life Scale,with the screening group showing significantly higher scores(SMD=20.83,95%CI:15.27-26.38,P<0.01).Mortality analysis indicated a reduction in five-year mortality rates for the PSD screening group.CONCLUSION Early PSD screening enhances functional recovery,improves quality of life,and reduces mortality rates in stroke survivors.Thus,integrating PSD screening into routine stroke care improves long-term outcomes for patients.
文摘Medical procedures are inherently invasive and carry the risk of inducing pain to the mind and body.Recently,efforts have been made to alleviate the discomfort associated with invasive medical procedures through the use of virtual reality(VR)technology.VR has been demonstrated to be an effective treatment for pain associated with medical procedures,as well as for chronic pain conditions for which no effective treatment has been established.The precise mechanism by which the diversion from reality facilitated by VR contributes to the diminution of pain and anxiety has yet to be elucidated.However,the provision of positive images through VR-based visual stimulation may enhance the functionality of brain networks.The salience network is diminished,while the default mode network is enhanced.Additionally,the medial prefrontal cortex may establish a stronger connection with the default mode network,which could result in a reduction of pain and anxiety.Further research into the potential of VR technology to alleviate pain could lead to a reduction in the number of individuals who overdose on painkillers and contribute to positive change in the medical field.
文摘Objective: This study compares the cardiorespiratory fitness of stroke patients with that of healthy control subjects matched by age and gender. It was a descriptive, analytical and comparative case-control study that aims to assess the aerobic capacity of stroke survivors in Cotonou. Methods: Data were collected during the Six-Minute Walk Test from 91 patients affected by stroke at least (03) three months ago and from 91 healthy subjects, who are at least 18 years old. Results: The average age was 53.16 ± 10.13 years with a sex ratio equal to 2.5. 45.05% of patients had ischemic strokes and 31.87% had strokes of unspecified origin. 59.34% of patients were right side affected, and almost all had a low level of physical activity. The average distance covered in relation to VO2 max was 276.39 ± 175.27 meters with an estimated VO2 max of 11.3 ± 4.03 ml/min/kg in patients and 464.14 ± 128.4 meters for an estimated VO2 max of 15.62 ± 8.72 ml/min/kg. These values were highly significantly influenced by age, post-stroke duration and level of exercise. Conclusion: The study revealed a low cardiorespiratory fitness in the study population, and suggests that post-stroke patients should be monitored by improving their aerobic endurance through an adapted physical activity program aimed at preventing recurrence.
文摘In this article, we present our previous research, which highlighted adenosine triphosphate(ATP) as the cause of neuropathic pain during the acute phase of neuromyelitis optica spectrum disorder(NMOSD). In NMOSD pathology, damageassociated molecular patterns(DAMPs), including ATP, are released from damaged astrocytes, triggering the activation of innate immune cells. ATP is a central mediator of acute pain in NMOSD.
文摘Vulvodynia,a chronic pain disorder affecting the vulvar region,represents a significant challenge in both diagnosis and treatment within the field of women’s health.This condition is characterized by chronic pain that significantly affects the quality of life of afflicted women.The present perspective paper examines the role of spinal sensitization and microglial activation in vulvodynia.
文摘In this editorial,we comment on a recent article by Chen et al,that addressed the effect of intraoperative injection of esketamine on postoperative analgesia and postoperative rehabilitation after cesarean section.Poor management of postcesarean pain is associated with decreased maternal care for the baby,longer hospitalization,and higher risk of developing postpartum depression.Esketamine is a more potent S-enantiomer of ketamine which has shown promising analgesic and antidepressant properties for managing post-cesarean pain and depression in clinical studies.However,due to its potential adverse effects on the neurological and hemodynamic status of patients,it is recommended that its usage in low doses should be limited to cesarean candidates experiencing unbearable pain.Before any recommendation for routine perioperative use of esketamine,more standardized clinical trials are needed to strengthen our existing knowledge of its effectiveness in reducing postpartum pain and depression.
文摘Objective Magnetoencephalography(MEG),a non-invasive neuroimaging technique,meticulously captures the magnetic fields emanating from brain electrical activity.Compared with MEG based on superconducting quantum interference devices(SQUID),MEG based on optically pump magnetometer(OPM)has the advantages of higher sensitivity,better spatial resolution and lower cost.However,most of the current studies are clinical studies,and there is a lack of animal studies on MEG based on OPM technology.Pain,a multifaceted sensory and emotional phenomenon,induces intricate alterations in brain activity,exhibiting notable sex differences.Despite clinical revelations of pain-related neuronal activity through MEG,specific properties remain elusive,and comprehensive laboratory studies on pain-associated brain activity alterations are lacking.The aim of this study was to investigate the effects of inflammatory pain(induced by Complete Freund’s Adjuvant(CFA))on brain activity in a rat model using the MEG technique,to analysis changes in brain activity during pain perception,and to explore sex differences in pain-related MEG signaling.Methods This study utilized adult male and female Sprague-Dawley rats.Inflammatory pain was induced via intraplantar injection of CFA(100μl,50%in saline)in the left hind paw,with control groups receiving saline.Pain behavior was assessed using von Frey filaments at baseline and 1 h post-injection.For MEG recording,anesthetized rats had an OPM positioned on their head within a magnetic shield,undergoing two 15-minute sessions:a 5-minute baseline followed by a 10-minute mechanical stimulation phase.Data analysis included artifact removal and time-frequency analysis of spontaneous brain activity using accumulated spectrograms,generating spectrograms focused on the 4-30 Hz frequency range.Results MEG recordings in anesthetized rats during resting states and hind paw mechanical stimulation were compared,before and after saline/CFA injections.Mechanical stimulation elevated alpha activity in both male and female rats pre-and post-saline/CFA injections.Saline/CFA injections augmented average power in both sexes compared to pre-injection states.Remarkably,female rats exhibited higher average spectral power 1 h after CFA injection than after saline injection during resting states.Furthermore,despite comparable pain thresholds measured by classical pain behavioral tests post-CFA treatment,female rats displayed higher average power than males in the resting state after CFA injection.Conclusion These results imply an enhanced perception of inflammatory pain in female rats compared to their male counterparts.Our study exhibits sex differences in alpha activities following CFA injection,highlighting heightened brain alpha activity in female rats during acute inflammatory pain in the resting state.Our study provides a method for OPM-based MEG recordings to be used to study brain activity in anaesthetized animals.In addition,the findings of this study contribute to a deeper understanding of pain-related neural activity and pain sex differences.
基金supported by the National Natural Science Foundation of China,Nos.82374561(to JD),82174490(to JF)the Medical and Health Science and Technology Program of Zhejiang Province,No.2021RC098(to JD)the Research Project of Zhejiang Chinese Medical University,Nos.2022JKZKTS44(to JD),2022FSYYZZ07(to JF).
文摘Pain is often comorbid with emotional disorders such as anxiety and depression.Hyperexcitability of the anterior cingulate cortex has been implicated in pain and pain-related negative emotions that arise from impairments in inhibitory gamma-aminobutyric acid neurotransmission.This review primarily aims to outline the main circuitry(including the input and output connectivity)of the anterior cingulate cortex and classification and functions of different gamma-aminobutyric acidergic neurons;it also describes the neurotransmitters/neuromodulators affecting these neurons,their intercommunication with other neurons,and their importance in mental comorbidities associated with chronic pain disorders.Improving understanding on their role in pain-related mental comorbidities may facilitate the development of more effective treatments for these conditions.However,the mechanisms that regulate gamma-aminobutyric acidergic systems remain elusive.It is also unclear as to whether the mechanisms are presynaptic or postsynaptic.Further exploration of the complexities of this system may reveal new pathways for research and drug development.
基金supported by the National Natural Science Foundation of China,Nos.82001178(to LW),81901129(to LH),82001175(to FX)Shanghai Sailing Program,No.20YF1439200(to LW)+1 种基金the Natural Science Foundation of Shanghai,China,No.23ZR1450800(to LH)and the Fundamental Research Funds for the Central Universities,No.YG2023LC15(to ZX)。
文摘Protein arginine methyltransferase-6 participates in a range of biological functions,particularly RNA processing,transcription,chromatin remodeling,and endosomal trafficking.However,it remains unclear whether protein arginine methyl transferase-6 modifies neuropathic pain and,if so,what the mechanisms of this effect.In this study,protein arginine methyltransferase-6 expression levels and its effect on neuropathic pain were investigated in the spared nerve injury model,chronic constriction injury model and bone cancer pain model,using immunohistochemistry,western blotting,immunoprecipitation,and label-free proteomic analysis.The results showed that protein arginine methyltransferase-6 mostly co-localized withβ-tubulinⅢin the dorsal root ganglion,and that its expression decreased following spared nerve injury,chronic constriction injury and bone cancer pain.In addition,PRMT6 knockout(Prmt6~(-/-))mice exhibited pain hypersensitivity.Furthermore,the development of spared nerve injury-induced hypersensitivity to mechanical pain was attenuated by blocking the decrease in protein arginine methyltransferase-6 expression.Moreover,when protein arginine methyltransferase-6 expression was downregulated in the dorsal root ganglion in mice without spared nerve injury,increased levels of phosphorylated extracellular signal-regulated kinases were observed in the ipsilateral dorsal horn,and the response to mechanical stimuli was enhanced.Mechanistically,protein arginine methyltransferase-6 appeared to contribute to spared nerve injury-induced neuropathic pain by regulating the expression of heterogeneous nuclear ribonucleoprotein-F.Additionally,protein arginine methyltransfe rase-6-mediated modulation of hete rogeneous nuclear ribonucleoprotein-F expression required amino atids 319 to 388,but not classical H3R2 methylation.These findings indicated that protein arginine methyltransferase-6 is a potential therapeutic target fo r the treatment of peripheral neuro pathic pain.
文摘Objectives: This study aimed to evaluate the prolonged therapeutic effects of a 35 kDa molecular weight hyaluronan fragment (HA35) in alleviating pain associated with myofascial pain syndrome (MPS). Hyaluronan interacts with various receptors in the human body, including CD44, LYVE-1, RHAMM, and TLR2, and is well-known for its analgesic effects when used in intra-articular or ultrasound-guided nerve trunk injections. Studies have shown that hyaluronidase cleaves high molecular weight HA to generate HA35, a low molecular weight fragment with enhanced tissue permeability, capable of binding to HA receptors on cell surfaces to produce broad-spectrum analgesic effects. Methods: Ten patients diagnosed with MPS were treated and assessed in this study. HA35 was administered through injection at a dosage of 100 mg daily for 15 days. Patients evaluated their MPS, overall pain levels, and treatment satisfaction using the Numerical Pain Rating Scale (NPRS), the Global Pain Scale (GPS), and the Treatment Satisfaction Questionnaire for Medication (TSQM 1.4). Follow-up evaluations were performed three months post-treatment to assess the duration of therapeutic effects. Results: Significant improvements were observed in NPRS, GPS, and TSQM scores both during and after the treatment period (P Conclusions: HA35 provides effective and sustained relief from pain associated with MPS, demonstrating a prolonged therapeutic benefit.
基金Supported by the Taichung Veterans General Hospital,No.TCVGH-1125401B.
文摘BACKGROUND Abdominal aortic aneurysm(AAA)repair often involves significant postoperative pain,traditionally managed with systemic opioids,which can cause undesirable side effects.This case report explores the novel use of a surgically-initiated rectus sheath block with a catheter-over-needle assembly for pain management in AAA repair.CASE SUMMARY A 67-year-old female with hypertension and previous aortic dissection underwent elective open repair of an infrarenal AAA,which had grown from 3.4 cm to 4.3 cm over 14 months.A rectus sheath block was initiated surgically for postoperative pain control.The patient reported low pain scores and did not require systemic intravenous opioids,enabling early ambulation and discharge on postoperative day seven without complications.By preventing complications of systemic opi-oids,the method indicating a promising direction for postoperative pain management in major vascular surgeries.CONCLUSION Surgically-initiated rectus sheath block as a valuable tool for managing postoperative pain in AAA repair.
文摘Postoperative pain is an acute pain that appears due to the surgical act, reaching its maximum intensity in the first 24 - 48 hours after surgery. Postoperative pain control reduces possible postoperative complications, as well as the patient’s stay in the medical institution. Objective: This study compared the effectiveness and side effects of oral transmucosal fentanyl citrate (OTFC) with IV morphine in the control of postoperative pain. Methods: Seventy-three patients (Fentanyl group: 27, morphine group: 46) were included. Changes in pain were evaluated with Visual Analog Scale (VAS) and Pain Relief Scale, Pain Intensity Differences (PID), Sum of Pain Intensity Differences (SPID), and Total Pain Relief (TOTPAR). At time zero, 15, 30, 45 min and 1, 2, 3, 4, 5 and 6 h. Results: The decrease in pain intensity measured by VAS was similar in both groups with no significant differences at any of the measurement points. Both products produced a significant increase in the Pain Relief scale, with no differences between groups at any of the measurement times. There were no differences between groups when comparing PID. Comparing SPID between groups, there were no differences at 15, 30 minutes, then there were significant differences in favor of the Fentanyl group up to 6 hours. Both products produced a significant increase in the TOPAR scale, with no differences between groups at any of the measurement times. The appearance of adverse effects was similar in both groups. Conclusions: Both products produced a significant reduction in the measures of pain intensity (VAS), increase of SPID, as well as a significant increase in the Pain Relief scale, a significant increase in the TOPAR scale, with no differences between the groups. The number of adverse effects was similar. The convenience of OTFC administration allows its administration without the special conditions needed for the administration of IV morphine.
文摘Introduction: Pain has been defined for more than 20 years by the International Association for the Study of Pain (IASP) as an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage. It has been recognized as a feature of Parkinson’s disease (PD) since the first descriptions of the disease. Material and Methods: This was a prospective descriptive study lasting six (06) months from November 1, 2023 to April 30, 2024. We included all patients diagnosed with PD and who had pain. Sociodemographic, clinical, paraclinical and therapeutic data were evaluated for each patient. Results: We identified a sample of 62 Parkinson’s patients, of whom 52 patients or 85.2% had associated pain. We noted a male predominance (38M/14F) and a sex ratio of 2.71. Musculoskeletal pain was common in 80% of our respondents. WHO level I, antidepressants and background treatment for KD were the most prescribed molecules. Conclusion: Our study shows a frequency of pain in PD. However, musculoskeletal pain is the most frequently encountered type of pain in PD patients. WHO step I analgesics, antidepressants and background treatment of KD were the main prescriptions in our study.
文摘Background: Osteopathic manual treatment (OMT) has been reported to have positive initial results for subjects with chronic non-specific back pain in a rural safety-net hospital. However, the effects of OMT following initial treatment have not been reported. Objective: To determine the effects of OMT for patients with chronic non-specific back pain in a rural safety-net hospital setting for an initial post-clinical and follow-up visit. Methods: A longitudinal, rolling admission, eleven-year study of cohort study with a primary complaint of chronic, non-specific back pain that had plateaued in improvement for a minimum of six months. One hundred and fifty-one subjects completed the first two study visits necessary for data collection, and fifty-nine subjects completed the follow-up visit after six months. Results: A two-way, mixed model, repeated measures ANOVA with pre- post1 and post2 (follow-up) treatment as the within variable and sex as the between subject variable showed a significant main effect from pre- to follow-up, (F (1, 57) = 21.171, P ηP2= 0.426), but not a significant interaction between time and sex (F (1, 57) = 0.279, P ηP2= 0.002). Conclusions: The results of this study support the hypothesis that OMT has a continued benefit in pain reduction and functional improvement beyond the initial treatment period. The rural, safety-net hospital setting made this study unique relative to the sample population.
