B.G.L. Almay

Epidemiology of motor neuron disease in northern Sweden

ABSTRACT All cases of motor neuron disease (MND), encompassing amyotrophic lateral sclerosis (ALS), progressive bulbar paralysis (PBP) and progressive spinal muscular atrophy (PSMA), in northern Sweden, diagnosed between 1969‐1980 have been analysed. 128 cases were found, corresponding to an average annual incidence rate of 1.67 per 100,000. The prevalence on December 31, 1980 was 4.8 per 100,000. Age‐specific incidence rates were higher in the high age groups with a maximum at 60‐64 years for males, at 70‐74 years for females and at 65‐69 years for the sexes combined. The median age at onset was 61 years.

Substance P in CSF of patients with chronic pain syndromes

&NA; Immunoreactive substance P was determined in lumbar CSF of 35 healthy volunteers and 60 patients with chronic pain syndromes of at least 6 months duration. No significant relationships were found between substance P levels and age, sex or body height. Substance P levels were lower in chronic pain patients, with either neurogenic (n = 23) or idiopathic pain (n = 37) syndromes, than in the healthy volunteers. Substance P levels were especially low in patients with neurogenic pain with lesions involving the extremities and in those with polyneuropathy, while patients with central pain or pain of the head or face had higher values. Substance P levels were related to depressive symptomatology as determined by means of visual analogue scales and to stable personality traits as determined by means of the Karolinska Scales of Personality (KSP). The most consistent (and inverse) relationship was found between substance P levels and the symptom ‘inner tension’ and between substance P levels and the personality trait ‘psychic anxiety.’

Personality traits in chronic pain patients related to endorphin levels in cerebrospinal fluid

Interindividual differences in endorphin levels may relate to widespread changes in adaptive processes, and endorphin levels may thus be related to personality traits. In 40 patients with chronic pain syndromes of both psychogenic and organic origin, endorphin levels in cerebrospinal fluid (CSF) were determined, and the patients completed Eysencks Personality Inventory (EPI) and the Cesarek Marke Personality Scheme. Twenty-seven of the patients also completed the Zuckerman Sensation Seeking Scale (SSS). As a comparison group 30 healthy volunteers completed the personality inventories. The chronic pain patients were characterized by guilt feelings, need for order, low need for autonomy, and low tendency toward sensation seeking. Low levels of endorphins in CSF were found in patients with high scores on all the subscales in the SSS and low scores on the neuroticism subscale in the EPI.

Relationship between platelet MAO activity and concentrations of 5-HIAA and HVA in cerebrospinal fluid in chronic pain patients

Platelet monoamine oxidase (MAO) activity and concentrations of 5-HIAA and HVA in the cerebrospinal fluid (CSF) were estimated in a series of 54 chronic pain patients. Platelet MAO activity was found to correlate, positively to CSF concentrations of 5-HIAA and HVA, which had been adjusted in order to eliminate the influence of age and body height. However, only the correlation with 5-HIAA reached a significant level. When partial correlations were sought, only the positive correlation between platelet MAO activity and CSF 5-HIAA remained. The results support the notion that platelet MAO ia a biological marker for some trait dependent property of the central serotonergic system.

Long-term high frequency transcutaneous electrical nerve stimulation (hi-TNS) in chronic pain. Clinical response and effects on CSF-endorphins, monoamine metabolites, substance P-like immunoreactivity (SPLI) and pain measures

Eighteen patients with chronic pain syndromes of organic origin were treated by means of high frequency transcutaneous nerve stimulation (hi-TNS). The CSF levels of receptorassayable Fraction I and II endorphins, substance P-like immunoreactivity (SPLI), and the monoamine metabolites 5-HIAA, HVA and MOPEG were measured before and after one week of daily treatment. Furthermore, the effects on experimental pain measures were determined. The therapeutic effect was evaluated after 30 days and 3 months of treatment. Patients with low initial concentrations of endorphins in CSF, lower than those observed in healthy volunteers, tended to have the best response to hi-TNS. There were significant increases in Fraction I endorphins and SPLI in CSF, most pronounced in the patients who responded. There were no significant changes in 5-HIAA, HVA or MOPEG in CSF. However, in early responders, the serotonin metabolite 5-HIAA tended to decrease as contrasted to an increase in non-responders. The difference between the groups was statistically significant. Confirming our earlier studies, the therapy induced changes in pain measures showed a significant, positive correlation with increasing Fraction I endorphins in CSF. Our results suggest that hi-TNS induces central changes in the endorphinergic, serotonergic and possibly substance-P-ergic systems.

Melatonin in serum and urine in patients with idiopathic pain syndromes.

In 16 healthy volunteers, 16 patients with neurogenic pain syndromes, 37 patients with idiopathic pain syndromes, and 30 depressed patients, melatonin in serum was determined at 2 a.m. when the peak concentration was expected. In a somewhat larger series comprising 53 healthy volunteers, 14 patients with neurogenic pain syndromes, and 35 patients with idiopathic pain syndromes, melatonin was measured in urine collected during the night in a standardized manner. Chronic pain patients (with neurogenic or idiopathic pain disorders) and depressed patients had significantly lower melatonin in serum at 2 a.m. than healthy volunteers. Chronic pain patients also had significantly lower melatonin in urine than healthy volunteers, even when age, sex, and body weight were taken into account. The low melatonin concentrations were related to increased depressive symptomatology, especially sadness, bodily discomfort, inner tension, concentration difficulties, and pain. As low concentrations of melatonin in serum and urine also are found in patients with depressive disorders, the results are in line with the suggestion that the chronic idiopathic pain syndrome may be a variant of depressive disease, or the two syndromes may share a common pathogenic mechanism.

Clinical characteristics of patients with idiopathic pain syndromes. Depressive symptomatology and patient pain drawings

&NA; The frequency of depressive symptomatology as estimated by means of self‐rating on a visual analogue scale and the pain drawings by patients were compared between healthy volunteers, patients with neurogenic pain syndromes and patients with idiopathic pain syndromes. All patients with chronic pain syndromes had significantly more depressive symptomatology than the healthy volunteers. Patients with idiopathic pain syndromes had significantly more inhibition symptoms — memory disturbances and concentration difficulties — than patients with neurogenic pain syndromes. In the pain drawings, estimated by means of the technique suggested by Margolis et al. [10], the idiopathic pain patients had significantly higher scores on both raw scores and weighted body surface scores than the patients with neurogenic pain syndromes. Thus, both self‐rating of depressive symptomatology and pain drawings can be of some help in the difficult clinical delineation between patients with idiopathic and neurogenic pain syndromes, respectively, but used as single measures, both methods have low discriminative power.

Predictors for the outcome of treatment with high frequency transcutaneous electrical nerve stimulation in patients with chronic pain

&NA; Seventy‐two patients suffering from chronic pain were treated with high frequency transcutaneous electrical nerve stimulation (hi‐TNS). Significant predictors for a positive result were pains of neurogenic origin and pains located mainly in the extremities. CSF endorphin levels were determined for 22 patients with organic pain and the group with positive results from the treatment had somewhat (but not significantly) lower levels of fraction I endorphins. Age, sex or reported severity of pain had no predictive value.

Personality traits in patients with idiopathic pain disorder.

ABSTRACT— In the present study, patients with idiopathic pain syndromes have been compared to healthy volunteers, patients with neurogenic pain syndromes and depressed patients as concerns stable personality traits. The personality traits were assessed by means of the Karolinska Scales of Personality (KSP). Patients with idiopathic pain syndromes were found to have high scores on scales measuring Muscular tension, Social desirability, Psychasthenia and Socialization. They had also high scores on the Inhibition of aggression factor. They had low scores on Impulsivity, Monotony avoidance, Indirect aggression, Verbal aggression and Suspicion. As compared to depressed patients, the pain patients were much more controlled, with higher scores on Socialization and Social desirability scales and like depressed patients with a tendency to inhibit aggression. Thus, as compared to depressed patients, the pain patients had less open anxiety but the same degree of muscular tension.

5-HIAA and HVA in CSF in patients with idiopathic pain disorders

Abstract Patients with idiopathic pain syndromes were compared with healthy volunteers and with patients suffering from chronic pain syndromes of neurogenic origin, with respect to the concentrations of the metabolites 5-hydroxy-indole-acetic acid (5-HIAA) and homovanillic acid (HVA) in cerebrospinal fluid (CSF). Patients with idiopathic pain syndromes were subdivided according to the presence or absence of somatic lesions. It was found that these groups did not differ in concentrations of 5-HIAA or HVA, at least not when values were corrected for age, sex, and body height. Patients with idiopathic pain syndromes were found to have low concentrations of 5-HIAA, but not of HVA, in CSF. These differences were also obvious when the values were corrected for age, sex, and body height. As low concentrations of 5-HIAA in CSF have previously been demonstrated in patients with depressive disorders, our results support the suggestion by Blumer and Heilbronn (1982) that the idiopathic pain syndrome is a variant of depressive disease. At least the two syndromes share a common pathogenetic mechanism—a disturbance in serotonergic turnover.