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

This article reviews the acute neural transmission of pain, pruritus, and nausea symptoms, which can begin in the periphery and/or viscera. The subsequent multiple pathways in the central nervous system that become involved in the processing of these symptoms are also discussed. The authors describe human brain imaging studies that have revealed consistent cortical and subcortical networks  activated by these symptoms, including sensory, limbic, and associative regions. In particular, the authors discuss information revealed by the studies regarding the primary somatosensory cortex, secondary somatosensory cortex, anterior cingulate cortex, insula, prefrontal cortex and thalamus, are the brain areas most commonly activated by noxious stimuli.  Finally, the authors describe treatment options for chronic presentations of these symptoms, which are, in part, based on central nervous processing of these sensations. Introduction Heightened somatic awareness (HSA) refers to a greater than average awareness for a variety of physical sensations and symptoms. Individuals with HSA have a tendency to notice and report nonspecific symptoms, such as shortness of breath, presyncope, and a variety of chronic pain conditions, pruritus, and nausea.1 While each sensation has unique neural transmission pathways to the spinal cord, there appears to be a convergent processing of these sensations at the level of the brain itself. As opposed to acute sensory symptoms, the perpetuation of c...
Source: Innovations in Clinical Neuroscience - Category: Neuroscience Authors: Tags: Current Issue Neurologic Systems and Symptoms Neurology Pain Review central processing nausea pruritus Source Type: research

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Authors: von Csiky-Sessoms S Abstract A 42-year-old male with skin type I and a history of rosacea and eczema presented with crusting, erythema, and pustules distributed on the left oral commissure. Angular cheilitis was diagnosed and regular petrolatum use recommended until resolution of the lesion. Eight days later, with no improvement in symptoms, fungal and bacterial cultures were performed which resulted in the growth of cutibacterium acnes, a variant of p. acnes. PMID: 31524997 [PubMed - in process]
Source: Journal of Drugs in Dermatology - Category: Dermatology Tags: J Drugs Dermatol Source Type: research
Authors: Ewy S, Pham H, Quan K, Su B, Tachdjian R Abstract Bullous pemphigoid (BP) is a rare blistering skin disease that is commonly treated with corticosteroids and immunosuppressive agents. Here, we present a 74-year-old woman with severe BP following a leg fracture who was successfully treated with omalizumab. We started her on a regimen of omalizumab 300 mg subcutaneously every 4 weeks, and within a week she reported significantly decreased pain and faster healing time of lesions. Incidentally, bilateral erythematous, non-blistering dermatitis developed 5 centimeters distal to the injection sites within a week...
Source: Journal of Drugs in Dermatology - Category: Dermatology Tags: J Drugs Dermatol Source Type: research
In this report, we present a patient with Raynaud’s phenomenon refractory to standard therapies whose symptoms resolved after treatment with BTX-A. Follow-up with the patient after one and five years showed no relapse or recurrence of symptoms. J Drugs Dermatol. 2019;18(9):943-945. PMID: 31524993 [PubMed - in process]
Source: Journal of Drugs in Dermatology - Category: Dermatology Tags: J Drugs Dermatol Source Type: research
Authors: Tanis R, Ferenczi K, Payette M Abstract Prurigo nodularis (PN) is a disease in which chronic scratching and picking of the skin due to intense pruritis results in papulonodules, notably in areas that are accessible to the patient. The pathophysiology is hypothesized to be mediated by a Th2 helper cell response, similar to that seen in atopic dermatitis, therefore, treatment of PN with dupilumab would be expected to elicit a therapeutic response. We demonstrated that treatment of PN with dupilumab significantly decreased pruritis and the size and number of new lesions after 2 months of treatment. J Drugs D...
Source: Journal of Drugs in Dermatology - Category: Dermatology Tags: J Drugs Dermatol Source Type: research
We present a patient with refractory neuropathic pain in a normotrophic spread-scar treated with the injection of BTA. A 47-year-old Caucasian female with a history of invasive melanoma of the left upper arm presented with pain in her excision scar, which she described as a “pins and needles” sensation alternating with a dull, deep ache. She had previously tried topical lidocaine, topical and intralesional steroids, and oral gabapentin without improvement. We treated the patient with 50 U of onabotulinumtoxinA intradermally at 1-1.5 cm intervals within and immediately around the perimeter of the scar. At 1-wee...
Source: Journal of Drugs in Dermatology - Category: Dermatology Tags: J Drugs Dermatol Source Type: research
This study assessed the associations between the use of IV sodium bicarbonate and mortality of patients with acute kidney injury and acidosis. Design: The study was conducted by using data from Beth Israel Deaconess Medical Center, which included several ICUs such as coronary care unit, cardiac surgery recovery unit, medical ICU, surgical ICU, and trauma-neuro ICU. Marginal structural Cox model was used to assess the relationship between receipt of sodium bicarbonate and hospital mortality, allowing pH, Paco2, creatinine, and bicarbonate concentration as time-varying predictors of sodium bicarbonate exposure while adjus...
Source: Critical Care Medicine - Category: Emergency Medicine Tags: Clinical Investigations Source Type: research
Is there an increased risk of developing de novo inflammatory bowel disease while under treatment with anti-TNF-alpha for other chronic inflammatory or immune-mediated diseases?Alimentary Pharmacology &Therapeutics
Source: Medscape Allergy Headlines - Category: Allergy & Immunology Tags: Gastroenterology Journal Article Source Type: news
CONCLUSIONS Arthroscopic superior capsule reconstruction currently appears to be the method of choice in unreconstructed supraspinatus and infraspinatus tear. Our group of patients shows that early clinical outcomes of SCR using xenograft are very promising. A significant pain relief and a considerable improvement in the range of motion of the operated shoulder joint were observed. No complication specifically associated with the use of xenograft has been reported as yet. A longer follow-up period and assessment of a larger group of patients will be necessary to confirm the success of this surgical procedure. Key words: ma...
Source: Acta Orthopaedica - Category: Orthopaedics Authors: Tags: Acta Chir Orthop Traumatol Cech Source Type: research
Rosenbaum J Abstract PURPOSE OF THE STUDY Lumbar spinal stenosis (LSS) is a serious and fairly frequent disorder with prevalence increasing with age which often results in a disability. The surgical procedures are often very risky due to the greater age of patients with severe stenosis and their comorbidities. The study aimed to assess the functional outcomes and complications in patients who underwent surgical treatment for LSS at one year postoperatively and to identify the differences in the functional outcomes, if any, in dependence on the number of operated segments. MATERIAL AND METHODS It was a prospective ...
Source: Acta Orthopaedica - Category: Orthopaedics Authors: Tags: Acta Chir Orthop Traumatol Cech Source Type: research
aacute;č P Abstract The team of authors presents a case of the patient who suffered an isolated unstable extra-articular distal ulnar fracture, the surgical treatment of which was affected by a postponed management in consequence of inadequate primary treatment. The primary non-operative treatment resulted in a complex malunion ad latus, ad axim and ad peripheriam. The malunion which led to a painful restricted range of motion of the forearm (59%), decreased hand grip strength and significant limitation of activities of daily living was surgically treated by a triplane corrective osteotomy at 11 months after inju...
Source: Acta Orthopaedica - Category: Orthopaedics Authors: Tags: Acta Chir Orthop Traumatol Cech Source Type: research
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