Browsing by Subject "chronic pain"

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  • Hotta, Jaakko; Saari, Jukka; Koskinen, Miika; Hlushchuk, Yevhen; Forss, Nina; Hari, Riitta (2017)
    Patients with complex regional pain syndrome (CRPS) display various abnormalities in central motor function, and their pain is intensified when they perform or just observe motor actions. In this study, we examined the abnormalities of brain responses to action observation in CRPS. We analyzed 3-T functional magnetic resonance images from 13 upper limb CRPS patients (all female, ages 31-58 years) and 13 healthy, age- and sex-matched control subjects. The functional magnetic resonance imaging data were acquired while the subjects viewed brief videos of hand actions shown in the first-person perspective. A pattern-classification analysis was applied to characterize brain areas where the activation pattern differed between CRPS patients and healthy subjects. Brain areas with statistically significant group differences (q <.05, false discovery rate-corrected) included the hand representation area in the sensorimotor cortex, inferior frontal gyrus, secondary somatosensory cortex, inferior parietal lobule, orbitofrontal cortex, and thalamus. Our findings indicate that CRPS impairs action observation by affecting brain areas related to pain processing and motor control. Perspective: This article shows that in CRPS, the observation of others' motor actions induces abnormal neural activity in brain areas essential for sensorimotor functions and pain. These results build the cerebral basis for action-observation impairments in CRPS. (C) 2016 by the American Pain Society
  • Ståhl, Gustav (Helsingfors universitet, 2016)
    Pain is an unpleasant feeling bound to affect us, both humans as animals, during our lifetimes. Thousands of people are suffering from chronic pain around the world, and chronic pain in animals and ways to treat it is rapidly gaining more and more interest. The pain network is a vastly intricate one, with complex interactions between a plethora of neurons and cells. Modern science has yet to shine a light on the complete process of pain sensation. Acupuncture has been used for thousands of years in treating pain amongst other problems and is today approved by the World Health Organization as a treatment for certain types of pain among other conditions. Wide research has been carried out during the last few decades as acupuncture is gaining ground in the Western world and while evidence of its analgesic effects and some mechanisms of action (e.g. endogenous opioid-release) have been found through studies, our understanding of the response elicited by acupuncture still remains incomplete. In the current study, material was gathered in form of questionnaires, which owners to dogs treated with acupuncture filled out. We then assessed the efficacy of acupuncture as a treatment method for dogs suffering from chronic pain by analysing improvements in mobility, quality of life and pain by means of the Helsinki Chronic Pain Index (HCPI), visual analogue scales (VAS) (n=5-9) and a comparative enquiry (n=85). Although no statistically significant differences were found, results were constantly indicative of improvement, and significant differences might have been found were it not for the small numbers of cases in the HCPI-and VAS-studies. While no conclusions can be drawn from the current study, the results may be guardedly interpreted as indicative of the analgesic abilities of acupuncture in treating chronic pain in dogs.
  • Matsubara, L. M.; Luna, S. P. L.; Teixeira, L. R.; Castilho, M. S.; Bjorkman, A. H.; Oliveira, H. S.; Anunciacao, L. F. C. (2019)
    We aimed to determine validity, reliability, and sensitivity of Helsinki's chronic pain index (HCPI) and stablish a correlation between HCPI in dogs with hip dysplasia (HD) using pressure sensitive walkway. Forty-owners of dogs with HD and 16 owners of health dogs filled a questionnaire. Dogs with HD were treated with carprofen 4.4mg/ kg (GT n=21) or with placebo (GP n=19), both were administered once a day for 4 weeks. Evaluation was performed by the owners using the questionnaire (HCPI), the Visual Analogue Scale for pain (VASpain) and the VAS for locomotion (VASloc). The evaluation was performed 2 weeks before the treatment began (A1), immediately after treatment (A2), two (S2), four (S4) and two weeks after the end of treatment (S6) and the lameness was evaluated by pressure sensitive walkway. The internal consistency of the data was considered excellent (Cronbach alpha coefficient=0.89). There was a moderate correlation between the HCPI and VASpain. For VASloc the correlation was good. However, there was no difference between treatments, indicating low sensibility. No correlation was observed between pressure sensitive walkway and HCPI. We concluded that the questionnaire has construct and criterion validity, reliability and can be applied in dogs with osteoarthritis in Portuguese-speaking countries.
  • Hotta, Jaakko; Zhou, Guangyu; Harno, Hanna; Forss, Nina; Hari, Riitta (2017)
    Introduction: Many central pathophysiological aspects of complex regional pain syndrome (CRPS) are still unknown. Although brain-imaging studies are increasingly supporting the contribution of the central nervous system to the generation and maintenance of the CRPS pain, the brain's white-matter alterations are seldom investigated. Methods: In this study, we used diffusion tensor imaging to explore white-matter changes in twelve CRPS-type-1 female patients suffering from chronic right upper-limb pain compared with twelve healthy control subjects. Results: Tract-based spatial-statistics analysis revealed significantly higher mean diffusivity, axial diffusivity, and radial diffusivity in the CRPS patients, suggesting that the structural connectivity is altered in CRPS. All these measures were altered in the genu, body, and splenium of corpus callosum, as well as in the left anterior and posterior and the right superior parts of the corona radiata. Axial diffusivity was significantly correlated with clinical motor symptoms at whole-brain level, supporting the physiological significance of the observed white-matter abnormalities. Conclusions: Altogether, our findings further corroborate the involvement of the central nervous system in CRPS.
  • Salonsalmi, Aino; Pietiläinen, Olli; Lahelma, Eero; Rahkonen, Ossi; Lallukka, Tea (2022)
    Aims: Chronic pain is a notable burden on public health, with past and present factors contributing to it. This study aimed to examine the associations between childhood adversities and chronic pain. Methods: Data on seven childhood adversities, chronic pain and disabling pain were derived from questionnaire surveys conducted in 2000, 2001 and 2002 among 40- to 60-year-old employees (response rate of 67%) of the City of Helsinki, Finland. The study included 8140 employees (80% women). Logistic regression was used in the analyses, and the results are presented as odds ratios (OR) and their 95% confidence intervals (CI). Age, sex, the father's education, the participant's education, marital status, working conditions, sleep problems and common mental disorders were included as covariates. Results: In the age-adjusted models, childhood economic difficulties (OR=1.60, 95% CI 1.41-1.81), childhood illness (OR=1.74, 95% CI 1.45-2.08), parental divorce (OR=1.26, 95% CI 1.07-1.48), parental alcohol problems (OR=1.34, 95% CI 1.18-1.52) and bullying at school or among peers (OR=1.59, 95% CI 1.37-1.89) were associated with chronic pain. Working conditions, sleep problems and common mental disorders each slightly attenuated the associations between childhood adversities and chronic pain. Childhood economic difficulties among women (OR=1.72, 95% CI 1.40-2.10), childhood illness (OR=1.40, 95% CI 1.07-1.82) and bullying at school or by peers (OR=1.91 95% CI 1.48-2.46) were also associated with disabling pain. Conclusions: Childhood adversities were associated with chronic pain in mid-life, and the associations mainly remained after adjustments. Investing in the well-being of children might prevent pain and promote well-being in mid-life.
  • Lehto, Maria (Helsingin yliopisto, 2020)
    Helsinki Chronic Pain Index (HCPI) is a validated clinical metrology instrument used to measure canine chronic pain. In pain assessment, it is recommended to use validated instruments, and behavioural changes provide the best basis for pain measurement. A measuring instrument is valid when it does what it is intended to do. Validation can be done using many different methods. The aim of this study was to investigate which items of the HCPI are still useful and psychometrically test a new structure of the HCPI (HCPI-E3) after four new questions had been added to the test. The data consisted of 1140 internet-based questionnaire responses from dog owners. The study dogs were divided into different groups based on their reported amount of pain symptoms, pain medications, and other treatments to relieve pain. Based on the comparison of different items, five possible structures of the new HCPI were developed and tested with different statistical methods. Based on the initial item comparison, the “vocalization” item was deleted from the HCPI. Overall, the “ease in” locomotion items showed better criterion validity than the “willingness to” items. Both of the “jumping” items performed excellent compared to the other locomotion item pairs, as well as the new structure containing both “jumping” items and only the “ease in” items from the other locomotion items. Thus, this structure was chosen to be the best candidate for the new structure of the HCPI. Jumping is an easily assessed activity, which does not occur too frequently, possibly making it easier to measure the dog’s willingness to do it compared to gait changes (walking, trotting, and galloping). The HCPI-E3 is a reliable tool for canine chronic pain measurement; however, future validation in the form of repeatability and reliability are still needed.
  • Wackström, Nanna; Koponen, Anne M.; Suominen, Sakari; Tarkka, Ina M.; Simonsen, Nina (2020)
    ABSTRACT Background: Physical activity (PA) is a key component in management of type 2 diabetes (T2D). Pain might be a barrier to PA especially among older adults with T2D, but surprisingly few studies have investigated the association between chronic pain and PA. Our aim was to evaluate the prevalence of chronic pain among older adults with T2D and to examine the association between chronic pain and PA while taking important life-contextual factors into account. Methods: Data of this register-based, cross-sectional study were collected in a survey among adults with T2D (n=2866). In the current study, only respondents aged 65?75 years were included (response rate 63%, n=1386). Data were analysed by means of descriptive statistics and multivariate logistic regression analysis. Results: In total, 64% reported chronic pain. In specific groups, e.g. women and those who were obese, the prevalence was even higher. Among respondents experiencing chronic pain, frequent pain among women and severe pain among both genders were independently associated with decreased likelihood of being physically active. Moreover, the likelihood of being physically active decreased with higher age and BMI, whereas it increased with higher autonomous motivation and feelings of energy. Among physically active respondents suffering from chronic pain, neither intensity nor frequency of pain explained engagement in exercise (as compared with incidental PA). Instead, men were more likely to exercise regularly as were those with good perceived health and higher autonomous motivation. Conclusions: The prevalence of chronic pain is high among older adults with T2D. This study shows that among those suffering from chronic pain, severe pain is independently and inversely associated with being physically active, as is frequent pain, but only among women. Moreover, the findings show the importance of autonomous motivation and health variables for both incidental PA and exercise among older adults with T2D experiencing chronic pain.
  • Zetterman, Teemu; Markkula, Ritva; Kalso, Eija (2022)
    Objectives. Fibromyalgia (FM), a common pain syndrome, is thought to be a non-inflammatory, nociplastic condition, but evidence implicating neuroinflammation has been increasing. Systemic inflammation may be associated with more severe symptoms in some FM patients. We studied healthy controls and FM patients with and without systemic inflammation detectable using high-sensitivity CRP (hsCRP) measurement. Methods. We measured hsCRP levels and gathered clinical and questionnaire data [including the Fibromyalgia Impact Questionnaire (FIQ)] from 40 female FM patients and 30 age-matched healthy women. An hsCRP level >3 mg/l was considered elevated. Results. FM patients had significantly higher mean hsCRP levels than controls, explained by overweight and lower leisure-time physical activity. Eight FM patients had elevated hsCRP levels and 29 had normal hsCRP levels. Levels of hsCRP were significantly correlated with FIQ scores. Patients with elevated hsCRP had higher FIQ scores, with worse physical functioning and greater pain and were less likely to be employed than patients with normal hsCRP. These patient groups did not differ by blood count, liver function or lipid profiles, nor by education, psychological measures, sleep disturbance, smoking or comorbidities. Conclusion. Some FM patients have elevated hsCRP, mostly due to overweight and physical inactivity. They have worse symptoms and their ability to work is impaired. Measurement of hsCRP may help to identify FM patients in greatest need of interventions supporting working ability.
  • Tanner, Johanna; Teerijoki-Oksa, Tuija; Kautiainen, Hannu; Vartiainen, Pekka; Kalso, Eija; Forssell, Heli (2022)
    Background: Health-related quality of life (HRQoL) of orofacial pain patients is lower than that of the general population and impaired in multiple dimensions. The aim of the present study was to investigate HRQoL of orofacial pain patients in comparison with patients suffering from other chronic pain disorders. Materials and Methods: One hundred and fifty-one tertiary care facial pain patients (mean age, 50 years; standard deviation [SD], 15; 119 females), were compared with 312 other non-cancer chronic pain patients (mean age, 46 years; SD, 13; 204 women), recruited from three multidisciplinary pain clinics in Finland. The groups were compared using the 15D, and pain-related measures such as pain interference, pain acceptance, anxiety, depression, and sleep. Statistical comparisons between groups were done using t test, chi(2) test, or analysis of covariance. Multivariate linear regression analysis was used to study whether pain-related aspects influencing HRQoL are similar between the patient groups. Results: The 15D score was significantly higher in facial pain patients (0.823; SD, 0.114) indicating better HRQoL in comparison with other chronic pain patients (0.732; SD, 0.107) (p < .001). The 15D profiles of studied populations resembled each other but orofacial pain patients showed significantly higher scores for most individual 15D dimensions. Dimensions regarding discomfort and symptoms and sleep were most affected in both groups. Orofacial pain patients showed less psychosocial disability and better acceptance of their pain. Pain acceptance was a weaker explanatory factor of HRQoL in orofacial pain patients. Conclusion: Compared to other non-cancer chronic pain, chronic pain in the orofacial area causes less impairment in HRQoL Orofacial pain patients showed less psychosocial disability and better pain acceptance.
  • Leino, Teppo (Helsingfors universitet, 2013)
    Voltage-gated sodium channels play an essential role in the function of the nervous system as they are responsible for producing action potentials. Abnormal activity of sodium channels is in connection to several diseases such as epilepsy and chronic pain. Voltage-gated sodium channel blockers which are selective towards a specific isoform could provide more efficient and better tolerated drugs to treat these diseases when compared to the drugs used today. Clathrodin is an alkaloid isolated from Caribbean sea sponge Agelas clathrodes. Bioactivity studies have shown that clathrodin changes the function of voltage-gated sodium channels. The aim of this study was to synthesize two kinds of structure analogs of clathrodin and study their structure-activity relationship towards different isoforms of voltage-gated sodium channels. The study is part of the MAREX project (Exploring Marine Resources for Bioactive Compounds: From Discovery to Sustainable Production and Industrial Applications) funded by the European Union. Intention of the project is to find new bioactive compounds in marine organisms. A four-step route was developed for synthesizing 2-aminobenzothiazole analogs. A three-step route was developed as well but the last step seemed to be problematic for some of the compounds. The three-step route provided new compounds as intermediates and some of them were sent to tests for activity. Synthesis of 1H-pyrrole-2-carboxamide analogs of clathrodin failed. 4,5-dihydrooxazole was recognized as a problem as it was formed as a result of a cyclization reaction when bromination was tried on the intermediate. The formed structure was used in synthesizing 2-(1H-pyrrol-2-yl)-4,5-dihydrooxazole analogs of clathrodin. These reactions failed to give any final products which could have been tested for activity. Eight synthesized compounds were sent to tests for activity. Results were received from two of them and they showed no activity towards the voltage-gated sodium channels in 10 µM concentrations. Discussion about structure-activity relationship is not possible based on two compounds only.
  • Markkola, Anne (Helsingfors universitet, 2001)
    Tutkimuksessa pyrittiin löytämään menetelmiä, joilla voitaisiin luotettavasti mitata koiran nivelrikon aiheuttamaa kroonista kipua ja arvioida kipuhoidon tarvetta. Tutkimukseen valittiin 41 koiraa, joilla oli diagnosoitu lonkkaniveldysplasiasta johtuva nivelrikko ja jotka omistajien mukaan kärsivät kroonisesta kivusta. Koirista otettiin verinäytteet, joista analysoitiin adrenaliinin, noradrenaliinin, β-endorfiinin, antidiureettisen hormonin ja kortisolin pitoisuudet. Kaksi riippumatonta eläinlääkäriä arvioi videolta koirien liikkumista. Koirien lonkat röntgenkuvattiin. Omistajat täyttivät kyselykaavakkeen koiransa käyttäytymisestä ja mielialasta sekä arvioivat koiransa kokemaa kipua ja liikkumisvaikeuksia visuaalisilla analogiasteikoilla (kipujana ja liikkumisjana). Verinäytteiden kontrolliryhmään valittiin 22 omistajien mukaan tervettä koiraa, joilla ei ollut minkäänlaisia kipuoireita. Kyselykaavakkeen ja visuaalisten analogiasteikoiden kontrolliryhmään valittiin 24 omistajien mukaan tervettä ja kivutonta koiraa. Eläinlääkäreiden ja omistajien arviot koirien liikkumisvaikeuksista korreloivat positiivisesti keskenään. Adrenaliinin, antidiureettisen hormonin ja kortisolin pitoisuudet plasmassa olivat korkeammat kroonisesta kivusta kärsivillä koirilla kuin kontrolliryhmän koirilla, kun taas β-endorfiinipitoisuudet olivat korkeammat kontrolliryhmän koirilla. Koirilla, joilla röntgenologisesti todettiin luupiikkimuodostusta tai irtopaloja lonkkanivelessä, oli omistajien arvioiden mukaan enemmän liikkumisvaikeuksia mutta ei kipuja kuin muilla tutkimukseen osallistuneilla koirilla. Yksittäisen koirapotilaan kroonisen kivun arvioimiseen ei tutkimuksessa löydetty luotettavaa hormonaalista tai röntgenologista muuttujaa. Tutkimuksen perusteella eläinlääkäri voi arvioida koiran kipua ainoastaan sen liikkumisen perusteella. Omistajan kertomuksella koiran käyttäytymisestä, mielialasta ja liikkumisesta on nivelrikkokivun arvioinnissa keskeinen rooli. Eläinlääkärin tulee tulkita omistajan kertomuksesta koiran kivusta kertovat seikat ja/tai opettaa omistaja tulkitsemaan koiransa kipuoireita.
  • Radoi, Vlad; Jakobsson, Gerd; Palada, Vinko; Nikosjkov, Andrej; Druid, Henrik; Terenius, Lars; Kosek, Eva; Vukojevic, Vladana (2022)
    The importance of the dynamic interplay between the opioid and the serotonin neuromodulatory systems in chronic pain is well recognized. In this study, we investigated whether these two signalling pathways can be integrated at the single-cell level via direct interactions between the mu-opioid (MOP) and the serotonin 1A (5-HT1A) receptors. Using fluorescence cross-correlation spectroscopy (FCCS), a quantitative method with single-molecule sensitivity, we characterized in live cells MOP and 5-HT1A interactions and the effects of prolonged (18 h) exposure to selected non-peptide opioids: morphine, codeine, oxycodone and fentanyl, on the extent of these interactions. The results indicate that in the plasma membrane, MOP and 5-HT1A receptors form heterodimers that are characterized with an apparent dissociation constant K-d(app) = (440 +/- 70) nM). Prolonged exposure to all non-peptide opioids tested facilitated MOP and 5-HT1A heterodimerization and stabilized the heterodimer complexes, albeit to a different extent: K-d,Fentanyl(app) = (80 +/- 70) nM), K-d,FMorphine(app) = (200 +/- 70) nM, K-d,Codeine(app) = (100 +/- 70) nM and K-d,(app)(Oxycodone) = (200 +/- 70) nM. The non-peptide opioids differed also in the extent to which they affected the mitogen-activated protein kinases (MAPKs) p38 and the extracellular signal-regulated kinase (Erk1/2), with morphine, codeine and fentanyl activating both pathways, whereas oxycodone activated p38 but not ERK1/2. Acute stimulation with different non-peptide opioids differently affected the intracellular Ca2+ levels and signalling dynamics. Hypothetically, targeting MOP-5-HT1A heterodimer formation could become a new strategy to counteract opioid induced hyperalgesia and help to preserve the analgesic effects of opioids in chronic pain.
  • Kotiranta, Ulla; Forssell, Heli; Kauppila, Timo (2019)
    Objective: We studied whether primary care temporomandibular disorder (TMD) patients reporting different levels of pain-related disability differ in terms of comorbid pains, general health conditions and quality of life. Material and methods: Consecutive TMD pain patients (n = 399) seeking treatment in primary care completed a questionnaire on comorbid pains and their interference and the Finnish version of the RAND-36-item quality of life questionnaire. Medical diagnoses confirmed by doctors were recorded. The patients were classified according to the Graded Chronic Pain Scale (GCPS) of the Research Diagnostic Criteria for TMD (RDC/TMD). The patients were classified: no disability group (0 disability points), low disability group (1-2 disability points) and high disability group (3-6 disability points). Results: Compared to patients in the no-disability group, patients in the high- and low-disability groups reported more comorbid pain conditions (p <.001), and experienced these as more intense and interfering more with daily life (p <.05). Patients in the high-disability group reported more general health-related medical diagnoses than patients in the no-disability group (p <.05). Furthermore, patients with low or high pain-related disability indicated poorer quality of life in all RAND-36 subscales than those with no disability (p <.05). Conclusions: The findings suggest that GCPS-related disability scoring can be used as a simple screening instrument to identify TMD patients with different degrees of health burdens.
  • Multanen, Juhani; Hakkinen, Arja; Heikkinen, Pauli; Kautiainen, Hannu; Mustalampi, Sirpa; Ylinen, Jari (2018)
    Low-energy pulsed electromagnetic field (PEMF) therapy has been suggested as a promising therapy to increase microcirculation, which is of great concern in patients with fibromyalgia. This study evaluated the effectiveness of PEMF therapy on the treatment of fibromyalgia. A group of 108 women with fibromyalgia were allocated to a 12-week treatment period with an active Bio-Electro-Magnetic-Energy-Regulation (BEMER) device and a similar treatment period with an inactive device. Each patient received active and sham treatments in a random order. Pain and stiffness were assessed on a visual analog scale (VAS, scale 0-100mm), and functional status was assessed by the Fibromyalgia Impact Questionnaire (FIQ). Mean VAS pain scores before the active and sham treatment periods were 66 (SD22) and 63 (SD22), respectively. After treatment periods, mean VAS pain scores had decreased significantly in active treatment, -12, 95% CI [-18, -6], and in sham treatment, -11, 95% CI [-17, -5]. Similarly, the decrease in stiffness and FIQ index after both treatments was statistically significant. However, per-protocol analysis showed no differences between active and sham treatments at any of the outcomes. This study demonstrated that low-energy PEMF therapy was not efficient in reducing pain and stiffness or in improving functioning in women with fibromyalgia. Bioelectromagnetics. 39:405-413, 2018. (c) 2018 Wiley Periodicals, Inc.
  • Kemppainen, Sanna (Helsingin yliopisto, 2020)
    This study describes personal chronic pain blog entries written in English by defining the common text types in the blogs. Text types are defined as text-classifying tools that combine a clause-level structural perspective and a whole-text level category perspective. On the clause level, each clause is defined as representing one of five Werlich's text types that reflect author focus on cognitive processes. The study also explores the effect of author socio-demographic attributes of gender, age and duration of chronic pain on the text types identfied in the analysis. Chronic pain is a common health condition that also affects the sufferer’s focus of attention. The text types in chronic pain blogs have not been studied even though studies have found that blog writing has therapeutic effects on pain management for chronic pain sufferers. Studies have also identified several purposes for writing chronic pain blogs. The purposes have been found to change for some of the chronic pain blog writers. Previous studies on blog types suggest two common text types. A combined qualitative-quantitative analysis of text-typical clauses and blog entries was conducted on a sample of 26 whole-text entries. The sample consists of two entries from 13 authors with total of 1068 clauses. Additionally, a socio-linguistic variable analysis was conducted with text types as dependent variables and author attributes as independent variables. The data was gathered with a combined purposive-snowball method with author chronic pain condition and personal authorship as sample selection criteria. The results show some overlapping analytical criteria for clause-level text types. The most frequent text types are identified as combinations of argumentation, instruction and narration with argumentation being surprisingly high in prevalence. The text-typical variation does not seem to be an effect of a specific author variable although the socio-linguistic analysis is not proved as statistically significant because of the small sample size. Further study on text types is suggested in a combined interpersonal feature and text type analysis of chronic pain blog entries. A different approach is also suggested in identification and comparison of hierarchical and text-organizational features such as Theme-Rheme analysis of clauses.
  • Wickholm, Grim (Helsingfors universitet, 2016)
    Chronic pain is challenging to treat when the adverse effects of the analgesic agents become significant when used for a long period of time. Acupuncture has been shown to have analgesic effect without adverse effects. The modulatory effect of acupuncture on pain and what substances are involved in the modulation is, however, not completely understood. In this study 19 dogs with chronic pain caused by osteoarthritis in the hip joint was randomly divided into two groups: acupuncture group (AG) and sham group (SG). The AG got three acupuncture treatments with an interval of about one week and the SG got no treatment, they just rested on the floor in the treatment room. The owners and the researchers did not know into which group each dog was divided. Blood samples was taken from each dog in the beginning and at the end of the study to analyse the long-term effect (LT) and before and after one treatment to analyse the short-term effect (ST). From the blood samples the plasma concentration of serotonin (ST), prolactin (LT) and cortisol (ST and LT) were analysed and the concentrations between the groups and between the samples before and after were compared. The result of the study was that there was no statistically significant difference neither between the two groups nor between the before and after samples for neither serotonin, prolactin nor cortisol. There was, however, a strong trend toward significance in the increased concentration of LT cortisol between baseline and end of treatment in the AG (p=0.051), and a decrease of concentration of ST cortisol in both groups (p=0.051 for the AG and p=0.063 for the SG). More research, taking into consideration the limitations of this study, should be done.
  • Rönkkä, Laura (Helsingfors universitet, 2015)
    Lonkkavika on merkittävä sairaus koirapopulaation keskuudessa ja sitä seuraava nivelrikko taas yleisin kroonisen kivun aiheuttaja. Lonkkavikaa on perinteisesti hoidettu esimerkiksi tulehduskipulääkkeillä ja kirurgialla, mutta koska edellä mainitut hoidot eivät välttämättä sivuvaikutusten tai kustannusten takia sovi kaikille, on tärkeää kehittää ja tutkia erilaisia vaihtoehtohoitomuotoja. Akupunktio on esimerkki ns. vaihtoehtolääketieteestä ja sen kiinnostus on lisääntynyt eläinlääketieteessä huomattavasti viime vuosikymmenien aikana. Akupunktiossa niin kutsuttuja akupisteitä voidaan stimuloida esimerkiksi ohuilla neuloilla ja siten perinteisen kiinalaisen näkemyksen mukaan palauttaa elimistön energiatasapaino ennalleen. Länsimaisen lääketieteen mukaan se vaikuttaa kipuun esimerkiksi porttikontrolliteorian sekä endogeenisten opioidien ja muiden yhdisteiden, kuten serotoniinin, erittymisen kautta. Akupunktion hyötyihin kuuluu sen verrattain helppo käyttö sekä haittavaikutusten vähäisyys. Tutkimuksen tavoitteena oli tutkia onko akupunktiosta apua koirien krooniseen kipuun subjektiivisen arvioinnin perusteella. Hypoteesina oli, että akupunktioryhmässä lonkkavikaisten koirien kivun ja liikuntavaikeuksien sekä kipulääkkeen käytön pitäisi pienentyä verrattuna kontrolliryhmään. Akupuntkioryhmän myös oletettiin käyttävän vähemmän kipulääkitystä tutkimuksen aikana. Päämuuttujina käytettiin HCPI-arvoa (Helsinki Chronic Pain Index) ja VAS-mittaria (Visual Analogue Scale), jotka laskettiin omistajien täyttämistä kyselylomakkeista, sekä eläinlääkäriopiskelijoiden tekemiä ontuma-arviointeja ravissa ja käynnissä. Tutkimus toteutettiin kaksoissokkoutettuna kontrolloituna tapausverrokkitutkimuksena ja se suunniteltiin osaksi laajempaa kansainvälistä tutkimusta. Tutkimukseen valittiin 1. arviointikäynnin perusteella yhteensä 19 koiraa, jotka jaettiin satunnaisesti kahteen ryhmään. Akupunktioryhmässä olleet koirat (10 kpl) saivat yhteensä kolme kertaa ohutneula-akupunktiohoitoa 45 minuutin ajan noin viikon välein. Lumeryhmässä olleet koirat (9 kpl) odottivat saman ajan tutkimushuoneessa eläinlääkrin kanssa saamatta mitään hoitoa. Hoitokäyntien yhteydessä koirille tehtiin myös ontumatutkimus, suppea ortopedinen tutkimus, askelvoimamittaus sekä otettiin verikokeita. Samat tutkimukset tehtiin myös viimeisellä arviointikäynnillä noin viikko viimeisen hoitokäynnin jälkeen. Tilastollisissa menetelmissä käytettiin pienen otoskoon vuoksi non-parametrisiä testejä ja P-arvon rajaksi asetettiin ≤0.05. Tutkimuksessa ei todettu tilastollisesti merkittävää eroa akupunktio- ja lumeryhmän välillä minkään muuttujan kohdalla. Kuitenkin, kun verrattiin muutosta alun ja lopun välillä, akupunktioryhmän sisällä havaittiin useissa muuttujissa (HCPI, elämänlaatu VAS sekä ontuma ravissa ja käynnissä) tilastollisesti merkittäviä eroja. Lumeryhmässä ainoastaan liikuntavaikeudet (VAS) vähenivät merkittävästi omistajien arvioinnin mukaan. Tulokset osoittavat, että akupunktiolla on todennäköisesti positiivista vaikutusta koirien krooniseen kipuun, mutta tämän tutkimuksen perusteella sitä ei voida kuitenkaan pitää tieteellisesti todistettuna tehokkaana hoitomuotona. Useat eri tekijät, kuten pieni otoskoko, heterogeeninen tutkimuspopulaatio, subjektiivisen arvioinnin heikko luotettavuus sekä merkittävä lumevaikutus varmasti vaikuttavat siihen, että ryhmien välille ei saatu tutkimuksessa eroa. Tulokset ovat kuitenkin rohkaisevia ja antavat odottaa positiivisempia tuloksia, kun kaikki osatutkimukset yhdistetään.
  • Forssell, Heli; Sipilä, Kirsi; Teerijoki-Oksa, Tuija; Vartiainen, Pekka; Kautiainen, Hannu; Sintonen, Harri; Kalso, Eija (2020)
    Background and aims: Health-related quality of life (HRQoL) assessments have been widely used in pain medicine as they are able to reflect the subjective and multidimensional nature of chronic pain. Studies have shown a consistent impairment in HRQoL in different chronic pain conditions. However, it is not known whether HRQoL is impaired in chronic orofacial pain (OFP). The generic 15D HRQoL instrument has been shown to fare as well as or better than other generic HRQoL instruments in the study of chronic pain. The aim was to investigate HRQoL in patients with chronic OFP using the generic 15D HRQoL instrument. The validity of the instrument was tested by studying the association of the 15D data with pain interference. Methods: One hundred fifty-one patients (mean age 50 years, SD 15 years, 119 females) were recruited from three tertiary facial pain clinics. HRQoL data of the participants were contrasted with that of an age- and gender-standardized sample of general population by comparing the mean 15D scores and profiles. The data for the general population came from the National Health 2011 Survey representing Finnish population aged 18 years and older. Pain interference was assessed using Brief Pain Inventory. Based on pain interference distribution the participants were divided into tertiles. Statistical comparison between patient and population HRQoL values were performed using Monte-Carlo-type simulations. Statistical significance for the hypothesis of linearity was evaluated by using generalized linear models. Results: The mean 15D score of OFP patients (0.824, SD 0.113) was statistically significantly lower than that of the age- and gender-standardized general population (0.929, SD 0.019) (p <0.001). The difference between the patients and the general population was also clinically important, i.e. over the minimum clinically important difference in the 15D score. All mean 15D dimension values were significantly lower compared with the general population values (p <0.001 for all dimensions). The largest differences were seen in the dimensions of discomfort and symptoms (0.418, SD 0.222 vs. 0.816, SD 0.027), sleeping (0.693, SD 0.258 vs. 0.838, SD 0.029), and vitality (0.702, SD 0.221 vs. 0.884 SD 0.026). There was a statistically significant linear decrease in the 15D dimension values (p <0.001) with increasing pain interference. The greatest differences were found on the dimensions of discomfort and symptoms, sleeping and vitality. Conclusions: HRQoL is significantly impaired in patients with chronic OFP. A decrease in the 15D dimension values with increasing pain interference indicated convergent validity between 15D and pain interference. Implications: The findings suggest that 15D is an appropriate instrument for use in the assessment of HRQoL in OFP patients. By showing the usefulness of the 15D, the present study may encourage further use of generic HRQoL assessments in the study of chronic OFP, and contribute e.g. to the implementation of HRQoL as one of the core outcome measures in future treatment studies on chronic OFP.