Laura Condon

Quantitative sensory testing in painful osteoarthritis: a systematic review and meta-analysis

OBJECTIVE To systematically review the use of quantitative sensory testing (QST) in pain characterisation (phenotyping) in osteoarthritis (OA). METHODS Six bibliographic databases (Medline, Embase, Amed, Cinahl, PubMed, Web of Science) were searched to identify studies published before May 2011. Data were extracted based on the primary site of OA, QST modalities, outcome measures and test sites. Standardised mean difference (SMD) and 95% confidence intervals (CIs) were calculated if possible. Publication bias was determined using funnel plot and Eggers test. Heterogeneity was examined using Cochran Q test and I2 statistic. Random effects model was used to pool the results. RESULTS Of 41 studies (2281 participants) included, 23 were case control studies, 15 case only studies, two randomised controlled trials, and one uncontrolled trial. The majority of studies examined pressure pain with smaller numbers using electrical and/or thermal stimuli. QST was more often applied to the affected joint than distal and remote sites. Of 20 studies comparing people with OA and healthy controls, seven provided sufficient information for meta-analysis. Compared with controls, people with OA had lower pressure pain thresholds (PPTs) both at the affected joint (SMD = -1.24, 95% CI -1.54, -0.93) and at remote sites (SMD = -0.88, 95% CI -1.11, -0.65). CONCLUSION QST of PPTs demonstrated good ability to differentiate between people with OA and healthy controls. Lower PPTs in people with OA in affected sites may suggest peripheral, and in remote sites central, sensitisation. PPT measurement merits further evaluation as a tool for phenotyping OA pain.

Functional reorganisation in chronic pain and neural correlates of pain sensitisation: A coordinate based meta-analysis of 266 cutaneous pain fMRI studies

Highlights ⿢ Neural maladaptation in chronic pain conditions is poorly understood.⿢ Large scale coordinate based meta-analysis of 266 cutaneous pain fMRI was performed.⿢ Results support a shared neural pain response in chronic pain and healthy subjects.⿢ Hyperalgesia leads to increased activation in an unchanged neural pattern.⿢ Chronic pain patients show functional reorganisation depending on stimulation site.

Associations of limbic-affective brain activity and severity of ongoing chronic arthritis pain are explained by trait anxiety

Functional magnetic resonance imaging studies (fMRI) have transformed our understanding of central processing of evoked pain but the typically used block and event-related designs are not best suited to the study of ongoing pain. Here we used arterial spin labelling (ASL) for cerebral blood flow mapping to characterise the neural correlates of perceived intensity of osteoarthritis (OA) pain and its interrelation with negative affect. Twenty-six patients with painful knee OA and twenty-seven healthy controls underwent pain phenotyping and ASL MRI at 3T. Intensity of OA pain correlated positively with blood flow in the anterior mid-cingulate cortex (aMCC), subgenual cingulate cortex (sgACC), bilateral hippocampi, bilateral amygdala, left central operculum, mid-insula, putamen and the brainstem. Additional control for trait anxiety scores reduced the pain-CBF association to the aMCC, whilst pain catastrophizing scores only explained some of the limbic correlations. In conclusion, we found that neural correlates of reported intensity of ongoing chronic pain intensity mapped to limbic-affective circuits, and that the association pattern apart from aMCC was explained by trait anxiety thus highlighting the importance of aversiveness in the experience of clinical pain.

Cerebral Cortical Thickness in Chronic Pain Due to Knee Osteoarthritis: The Effect of Pain Duration and Pain Sensitization

Objective This study investigates associations between cortical thickness and pain duration, and central sensitization as markers of pain progression in painful knee osteoarthritis. Methods Whole brain cortical thickness and pressure pain thresholds were assessed in 70 participants; 40 patients with chronic painful knee osteoarthritis (age = 66.1± 8.5 years, 21 females, mean duration of pain = 8.5 years), and 30 healthy controls (age = 62.7± 7.4, 17 females). Results Cortical thickness negatively correlated with pain duration mainly in fronto-temporal areas outside of classical pain processing areas (p<0.05, age-controlled, FDR corrected). Pain sensitivity was unrelated to cortical thickness. Patients showed lower cortical thickness in the right anterior insula (p<0.001, uncorrected) with no changes surviving multiple test correction. Conclusion With increasing number of years of suffering from chronic arthritis pain we found increasing cortical thinning in extended cerebral cortical regions beyond recognised pain-processing areas. While the mechanisms of cortical thinning remain to be elucidated, we show that pain progression indexed by central sensitization does not play a major role.

Towards an Engaging Mobile Food Record for Teenagers

In the frame of the PEGASO European project, we aim at promoting healthier lifestyles among teenagers focusing on the alimentary education and physical activity. This paper presents a novel concept of mobile food record developed following a multidisciplinary approach to innovate both the monitoring and the user experience. This mobile food record does not count calories but is focused on tracking dietary patterns and support the adoption of target behaviours. Moreover, the introduction of game mechanics developed through participatory design techniques aims at sustaining engagement in the long term.

Promoting Healthy Adolescent Lifestyles Through Serious Games: Enacting a Multidisciplinary Approach

Long-term health risks associated with unhealthy lifestyles present a significant current and future burden for healthcare providers. Adolescence represents a critical time for intervention, as habits formed during this period can persist throughout adult life. Given the prevalence of gaming as an entertainment medium amongst adolescents, and subsequent potential for engagement, the use of serious games to promote changes in lifestyle behaviour offers a potential solution. Creating such games requires a breadth of multidisciplinary expertise, working collaboratively to create research-informed designs which reflect both behavioural theory and entertainment game design best practices. In this chapter, challenges and benefits associated with multidisciplinary design are identified and discussed, with strategies presented to overcome and avoid potential issues. With reference to a current project, the perspectives of the theorist, iterative designer, and game developer are contrasted, providing a reference for future projects implementing multidisciplinary approaches to serious game design.

Designing and Delivering Interventions for Health Behavior Change in Adolescents Using Multitechnology Systems: From Identification of Target Behaviors to Implementation

When designing behavior change interventions it is fundamental to gain an in-depth understanding of both the target behavior(s), and the issues surrounding the implementation, adherence, and acceptance of the intervention among its target population. The chapter discusses these design issues and presents a case study from an EU-funded project (Grant Ref: 610727) to develop a personalized ICT guidance service for optimizing healthy dietary and exercise lifestyle behaviors in European teenagers through increasing health awareness, motivation, and engagement. Attention will be paid to methods of identifying and understanding target health behaviors in this population, particularly the use of triangulated research methodology when building these representations and selecting behavior change techniques (BCTs) that are integral to the values, beliefs, and behavioral patterns of target populations. Implementation issues and modes of delivery will also be discussed, along with further considerations for designing mHealth behavior change interventions.

Biopsychosocial Intervention for Stroke Carers (BISC): protocol for a feasibility randomised controlled trial (RCT)

Introduction Reducing length of hospital stay for stroke survivors often creates a shift in the responsibility of care towards informal carers. Adjustment to the caregiving process is experienced by many carers as overwhelming, complex and demanding and can have a detrimental impact on mental and physical health and well-being. National policy guidelines recommend that carers’ needs are considered and addressed; despite this, few interventions have been developed and empirically evaluated. We developed a biopsychosocial intervention in collaboration with carers of stroke survivors. Our aim is to determine whether the intervention can be delivered in a group setting and evaluated using a randomised controlled trial (RCT). Methods and analysis Feasibility RCT and nested qualitative interview study. We aim to recruit up to 40 stroke carers within 1 year of the stroke onset. Carers are randomised to usual care or usual care plus biopsychosocial intervention. Each intervention group will consist of five stroke carers. The intervention will focus on: psychoeducation, psychological adjustment to stroke, strategies for reducing unwanted negative thoughts and emotions and problem-solving strategies. The main outcome is the feasibility of conducting an RCT. Carer outcomes at 6 months include: anxiety and depression, quality of life and carer strain. Data are also collected from stroke survivors at baseline and 6 months including: level of disability, anxiety and depression, and quality of life. Ethics and dissemination Favourable ethical opinion was provided by East Midlands – Nottingham2 Research Ethics Committee (14/EMI/1264). This study will determine whether delivery of the biopsychosocial intervention is feasible and acceptable to stroke carers within a group format. It will also determine whether it is feasible to evaluate the effects of the biopsychosocial intervention in an RCT. We will disseminate our findings through peer-reviewed publications and presentations at national and international conferences. Trial registration number ISRCTN15643456; Pre-results.

PEGASO Companion: A Mobile App to Promote Healthy Lifestyles Among Adolescents

Promoting healthy lifestyles can be a successful weapon in counter-fighting the epidemics of overweight and obesity. The PEGASO project aims at encouraging adolescents to become co-creators of their own health. In particular, it aims at creating an ecosystem where adolescents are motivated and supported in adopting healthy lifestyles. In this ecosystem, the PEGASO Companion, a smartphone app, plays the role of universal access to healthy services and providing personalised mechanisms to support behaviour change.

Personalised Guidance Services for Optimising Lifestyle in Teen-Agers Through Awareness, Motivation and Engagement – PEGASO: A Pilot Study Protocol

Adolescence is a vulnerable stage in which the development of certain unhealthy behaviours can occur. The prevalence of overweight and obesity among European teenagers is rapidly increasing and may lead to both short- and long-term health complications. The fast development of the ICT, and in particular mobile technologies, together with their increasing diffusion among the EU populations offers an important opportunity for facing these issues in an innovative manner introducing the possibility of a new technological framework to re-design the healthcare system model. The PEGASO project relies on a mobile-and cloud-based ICT platform to set up a system of new healthcare services targeted to teens for obesity prevention. The present paper describes the protocol of a six-month Pilot Study that will be carried out on 525 adolescents in four different European sites (Italy, Catalonia, England, Scotland), aiming to evaluate the PEGASO system usability and effectiveness in promoting healthy lifestyles.