TY - JOUR A1 - Arnold, Michaela Maria A1 - Müller-Oerlinghausen, Bruno A1 - Hemrich, Norbert A1 - Bönsch, Dominikus T1 - Effects of Psychoactive Massage in Outpatients with Depressive Disorders: A Randomized Controlled Mixed-Methods Study JF - Brain Sciences N2 - The clinical picture of depressive disorders is characterized by a plethora of somatic symptoms, psychomotor retardation, and, particularly, anhedonia. The number of patients with residual symptoms or treatment resistance is high. Touch is the basic communication among humans and animals. Its application professionally in the form of, e.g., psychoactive massage therapy, has been shown in the past to reduce the somatic and mental symptoms of depression and anxiety. Here, we investigated the effects of a specially developed affect-regulating massage therapy (ARMT) vs. individual treatment with a standardized relaxation procedure, progressive muscle relaxation (PMR), in 57 outpatients with depression. Patients were given one ARMT or PMR session weekly over 4 weeks. Changes in somatic and cognitive symptoms were assessed by standard psychiatric instruments (Hamilton Depression Scale (HAMD) and the Bech–Rafaelsen–Melancholia–Scale (BRMS)) as well as a visual analogue scale. Furthermore, oral statements from all participants were obtained in semi-structured interviews. The findings show clear and statistically significant superiority of ARMT over PMR. The results might be interpreted within various models. The concept of interoception, as well as the principles of body psychotherapy and phenomenological aspects, offers cues for understanding the mechanisms involved. Within a neurobiological context, the significance of C-tactile afferents activated by special touch techniques and humoral changes such as increased oxytocin levels open additional ways of interpreting our findings. KW - massage therapy KW - psychoactive massage KW - affect-regulating massage therapy KW - affective touch KW - depression KW - pain KW - interoception KW - C-tactile fibers KW - body psychotherapy Y1 - 2020 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-213385 SN - 2076-3425 VL - 10 IS - 10 ER - TY - JOUR A1 - Ben-Kraiem, Adel A1 - Sauer, Reine-Solange A1 - Norwig, Carla A1 - Popp, Maria A1 - Bettenhausen, Anna-Lena A1 - Atalla, Mariam Sobhy A1 - Brack, Alexander A1 - Blum, Robert A1 - Doppler, Kathrin A1 - Rittner, Heike Lydia T1 - Selective blood-nerve barrier leakiness with claudin-1 and vessel-associated macrophage loss in diabetic polyneuropathy JF - Journal of Molecular Medicine N2 - Diabetic polyneuropathy (DPN) is the most common complication in diabetes and can be painful in up to 26% of all diabetic patients. Peripheral nerves are shielded by the blood-nerve barrier (BNB) consisting of the perineurium and endoneurial vessels. So far, there are conflicting results regarding the role and function of the BNB in the pathophysiology of DPN. In this study, we analyzed the spatiotemporal tight junction protein profile, barrier permeability, and vessel-associated macrophages in Wistar rats with streptozotocin-induced DPN. In these rats, mechanical hypersensitivity developed after 2 weeks and loss of motor function after 8 weeks, while the BNB and the blood-DRG barrier were leakier for small, but not for large molecules after 8 weeks only. The blood-spinal cord barrier remained sealed throughout the observation period. No gross changes in tight junction protein or cytokine expression were observed in all barriers to blood. However, expression of Cldn1 mRNA in perineurium was specifically downregulated in conjunction with weaker vessel-associated macrophage shielding of the BNB. Our results underline the role of specific tight junction proteins and BNB breakdown in DPN maintenance and differentiate DPN from traumatic nerve injury. Targeting claudins and sealing the BNB could stabilize pain and prevent further nerve damage. KW - macrophages KW - neuropathy KW - barrier KW - pain Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-265237 VL - 99 IS - 9 ER - TY - THES A1 - Dietz, Christopher Andreas T1 - Distinguishing phenotypes of Complex Regional Pain Syndrome T1 - Phänotypen des komplexen regionalen Schmerzsyndroms N2 - This work investigated phenotypes of complex regional pain syndrome (CRPS) with special interest in sensory abnormalities. Quantitative sensory testing (QST) was used to assess sensory function. In addition, clinical and sensory differences of fracture and CRPS patients were addressed. Finally, the longitudinal outcome of CRPS patients was part of this thesis. N2 - Diese Arbeit untersuchte Phänotypen des komplexen regionalen Schmerzsyndroms (CRPS) mit einem besonderen Augenmerk auf sensorischen Veränderungen. Diese sensorischen Auffälligkeiten wurden mittels quantitativer sensorischer Testung (QST) untersucht. Außerdem wurden klinische und sensorische Unterschiede zwischen Fraktur- und CRPS-Patient*Innen erarbeitet. Schließlich befasste sich diese Arbeit mit dem Langzeitverlauf des CRPS. KW - Complex regional pain syndrome KW - CRPS KW - Quantitative sensory testing KW - QST KW - pain KW - chronic pain KW - Komplexes regionales Schmerzsyndrom Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-256327 ER - TY - JOUR A1 - Eder, Andreas B. A1 - Maas, Franzisca A1 - Schubmann, Alexander A1 - Krishna, Anand A1 - Erle, Thorsten M. T1 - Motivations underlying self-infliction of pain during thinking for pleasure JF - Scientific Reports N2 - Previous research suggested that people prefer to administer unpleasant electric shocks to themselves rather than being left alone with their thoughts because engagement in thinking is an unpleasant activity. The present research examined this negative reinforcement hypothesis by giving participants a choice of distracting themselves with the generation of electric shock causing no to intense pain. Four experiments (N = 254) replicated the result that a large proportion of participants opted to administer painful shocks to themselves during the thinking period. However, they administered strong electric shocks to themselves even when an innocuous response option generating no or a mild shock was available. Furthermore, participants inflicted pain to themselves when they were assisted in the generation of pleasant thoughts during the waiting period, with no difference between pleasant versus unpleasant thought conditions. Overall, these results question that the primary motivation for the self-administration of painful shocks is avoidance of thinking. Instead, it seems that the self-infliction of pain was attractive for many participants, because they were curious about the shocks, their intensities, and the effects they would have on them. KW - pain KW - self-infliction KW - thinking Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-301059 VL - 12 IS - 1 ER - TY - JOUR A1 - Evdokimov, Dimitar A1 - Dinkel, Philine A1 - Frank, Johanna A1 - Sommer, Claudia A1 - Üçeyler, Nurcan T1 - Characterization of dermal skin innervation in fibromyalgia syndrome JF - PLoS One N2 - Introduction We characterized dermal innervation in patients with fibromyalgia syndrome (FMS) as potential contribution to small fiber pathology. Methods Skin biopsies of the calf were collected (86 FMS patients, 35 healthy controls). Skin was immunoreacted with antibodies against protein gene product 9.5, calcitonine gene-related peptide, substance P, CD31, and neurofilament 200 for small fiber subtypes. We assessed two skin sections per patient; on each skin section, two dermal areas (150 x 700 mu m each) were investigated for dermal nerve fiber length (DNFL). Results In FMS patients we found reduced DNFL of fibers with vessel contact compared to healthy controls (p<0.05). There were no differences for the other nerve fiber subtypes. Discussion We found less dermal nerve fibers in contact with blood vessels in FMS patients than in controls. The pathophysiological relevance of this finding is unclear, but we suggest the possibility of a relationship with impaired thermal tolerance commonly reported by FMS patients. KW - nerve-fibers KW - cutaneous innervation KW - substance-P KW - pain KW - classification KW - reinnervation KW - expression KW - diagnosis KW - epidermis KW - criteria Y1 - 2020 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-229299 VL - 15 IS - 1 ER - TY - JOUR A1 - Fröhlich, Ellen A1 - Sassenrath, Claudia A1 - Nadji-Ohl, Minou A1 - Unteroberdörster, Meike A1 - Rückriegel, Stefan A1 - Brelie, Christian von der A1 - Roder, Constantin A1 - Forster, Marie-Therese A1 - Schommer, Stephan A1 - Löhr, Mario A1 - Pala, Andrej A1 - Goebel, Simone A1 - Mielke, Dorothee A1 - Gerlach, Rüdiger A1 - Renovanz, Mirjam A1 - Wirtz, Christian Rainer A1 - Onken, Julia A1 - Czabanka, Marcus A1 - Tatagiba, Marcos Soares A1 - Rohde, Veit A1 - Ernestus, Ralf-Ingo A1 - Vajkoczy, Peter A1 - Gansland, Oliver A1 - Coburger, Jan T1 - Resilience in lower grade glioma patients JF - Cancers N2 - Current data show that resilience is an important factor in cancer patients’ well-being. We aim to explore the resilience of patients with lower grade glioma (LGG) and the potentially influencing factors. We performed a cross-sectional assessment of adult patients with LGG who were enrolled in the LoG-Glio registry. By phone interview, we administered the following measures: Resilience Scale (RS-13), distress thermometer, Montreal Cognitive Assessment Test for visually impaired patients (MoCA-Blind), internalized stigmatization by brain tumor (ISBI), Eastern Cooperative Oncological Group performance status (ECOG), patients’ perspective questionnaire (PPQ) and typical clinical parameters. We calculated correlations and multivariate regression models. Of 74 patients who were assessed, 38% of those showed a low level of resilience. Our results revealed significant correlations of resilience with distress (p < 0.001, −0.49), MOCA (p = 0.003, 0.342), ECOG (p < 0.001, −0.602), stigmatization (p < 0.001, −0.558), pain (p < 0.001, −0.524), and occupation (p = 0.007, 0.329). In multivariate analyses, resilience was negatively associated with elevated ECOG (p = 0.020, β = −0.383) and stigmatization levels (p = 0.008, β = −0.350). Occupation showed a tendency towards a significant association with resilience (p = 0.088, β = −0.254). Overall, low resilience affected more than one third of our cohort. Low functional status is a specific risk factor for low resilience. The relevant influence of stigmatization on resilience is a novel finding for patients suffering from a glioma and should be routinely identified and targeted in clinical routine. KW - resilience KW - lower grade glioma KW - diffuse astrocytoma KW - oligodendroglioma KW - RS-13 KW - distress KW - internalized stigmatization KW - ISBI KW - occupation KW - pain Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-297518 SN - 2072-6694 VL - 14 IS - 21 ER - TY - JOUR A1 - García-Fernández, Patricia A1 - Reinhold, Colette A1 - Üçeyler, Nurcan A1 - Sommer, Claudia T1 - Local inflammatory mediators involved in neuropathic pain JF - International Journal of Molecular Sciences N2 - Polyneuropathy (PNP) is a term to describe diseases of the peripheral nervous system, 50% of which present with neuropathic pain. In some types of PNP, pain is restricted to the skin distally in the leg, suggesting a local regulatory process leading to pain. In this study, we proposed a pro-inflammatory pathway mediated by NF-κB that might be involved in the development of pain in patients with painful PNP. To test this hypothesis, we have collected nerve and skin samples from patients with different etiologies and levels of pain. We performed RT-qPCR to analyze the gene expression of the proposed inflammatory pathway components in sural nerve and in distal and proximal skin samples. In sural nerve, we showed a correlation of TLR4 and TNFα to neuropathic pain, and an upregulation of TNFα in patients with severe pain. Patients with an inflammatory PNP also presented a lower expression of TRPV1 and SIRT1. In distal skin, we found a reduced expression of TLR4 and miR-146-5p, in comparison to proximal skin. Our findings thus support our hypothesis of local inflammatory processes involved in pain in PNP, and further show disturbed anti-inflammatory pathways involving TRPV1 and SIRT1 in inflammatory PNP. KW - polyneuropathy KW - pain KW - inflammation KW - NF-κB KW - TNFα Y1 - 2023 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-313613 SN - 1422-0067 VL - 24 IS - 9 ER - TY - THES A1 - Klein, Thomas T1 - Establishing an in vitro disease model for Fabry Disease using patient specific induced pluripotent stem cell-derived sensory neurons T1 - Etablierung eines in vitro Krankheitsmodells für M. Fabry mittels patienteneigener sensibler Neurone, generiert über induzierte pluripotente Stammzellen N2 - Fabry disease (FD) is an X-linked lysosomal storage disorder caused by deficiency of the α-galactosidase A (GLA), leading to intracellular accumulations of globotriaosylceramide (Gb3). Acral burning pain, which can be triggered by heat, fever or physical activity is an early hallmark of FD and greatly reduces patients’ quality of life. The pathophysiology of FD pain is unknown and research is hindered by the limited in vivo availability of suitable human biomaterial. To overcome this obstacle, we generated induced pluripotent stem cells (iPSC) from one female and two male patients with a differing pain phenotype, and developed a refined differentiation protocol for sensory neurons to increase reliability and survival of these neurons, serving as an in vitro disease model. Neurons were characterized for the correct neuronal subtype using immunocytochemistry, gene expression analysis, and for their functionality using electrophysiological measurements. iPSC and sensory neurons from the male patients showed Gb3 accumulations mimicking the disease phenotype, whereas no Gb3 depositions were detected in sensory neurons derived from the female cell line, likely caused by a skewed X-chromosomal inactivation in favor of healthy GLA. Using super-resolution imaging techniques we showed that Gb3 is localized in neuronal lysosomes of male patients and in a first experiment using dSTORM microscopy we were able to visualize the neuronal membrane in great detail. To test our disease model, we treated the neurons with enzyme replacement therapy (ERT) and analyzed its effect on the cellular Gb3 load, which was reduced in the male FD-lines, compared to non-treated cells. We also identified time-dependent differences of Gb3 accumulations, of which some seemed to be resistant to ERT. We also used confocal Ca2+ imaging to investigate spontaneous neuronal network activity, but analysis of the dataset proofed to be difficult, nonetheless showing a high potential for further investigations. We revealed that neurons from a patient with pain pain are more easily excitable, compared to cells from a patient without pain and a healthy control. We provide evidence for the potential of patient-specific iPSC to generate a neuronal in vitro disease model, showing the typical molecular FD phenotype, responding to treatment, and pointing towards underlying electrophysiological mechanisms causing different pain phenotypes. Our sensory neurons are suitable for state-of-the-art microscopy techniques, opening new possibilities for an in-depth analysis of cellular changes, caused by pathological Gb3 accumulations. Taken together, our system can easily be used to investigate the effect of the different mutations of GLA on a functional and a molecular level in affected neurons. N2 - Morbus Fabry (M. Fabry) ist eine X-chromosomal vererbte lysosomale Speichererkrankung, die durch die Defizienz von α-Galaktosidase A (GLA) verursacht wird. Diese führt zu pathologischen Ablagerungen von Globotriaosylceramid (Gb3) in Zellen. Akraler, brennender Schmerz, der durch Hitze, Fieber oder Sport ausgelöst werden kann, ist ein frühes Krankheitsmerkmal und reduziert die Lebensqualität der Patienten deutlich. Die Pathophysiologie von M. Fabry ist unklar und die Forschung ist durch die limitierte Verfügbarkeit von humanem Biomaterial nur eingeschränkt möglich. Um dieses Problem zu bewältigen haben wir induzierte pluripotente Stammzellen (iPSC) von einer weiblichen Patientin und zwei männlichen Patienten mit unterschiedlichen Schmerzphänotypen generiert. Mit diesen Zellen konnten wir ein verbessertes Protokoll zur Herstellung sensibler Neurone etablieren um diese als in vitro Krankheitsmodell zu nutzen. Die Neurone wurden mittels Immunozytochemie, Genexpressionsanalyse und elektrophysiologischer Messungen auf die korrekte Zellidentität und deren Funktionalität getestet. Gb3 Ablagerungen konnten als Krankheitsmerkmal in iPSC und sensiblen Neuronen der männlichen Patienten, nicht aber in Zellen der weiblichen Patientin und der Kontrollperson nachgewiesen werden. Das Fehlen von pathologischen Ablagerungen in Zellen der weiblichen Betroffenen ist vermutlich auf eine verschobene X-Inaktivierung zu Gunsten des gesunden GLA zurückzuführen. Nichtsdestotrotz ist es uns durch die Nutzung hochauflösender Mikroskopietechniken gelungen, bei männlichen Patienten Gb3 in neuronalen Lysosomen nachzuweisen und die Membran in großem Detail abzubilden. Die Behandlung der Neurone mit der Enzymersatztherapie (ERT) als Nachweis für die Funktionalität des Krankheitsmodells führte zu einer Reduktion der Gb3 Ablagerungen bei männlichen Zellen, im Vergleich zu unbehandelten Zellen. Zudem konnten wir unterschiedliche Arten von Gb3 Akkumulationen identifizieren, von denen einige scheinbar behandlungsresistent sind. Erste Versuche mit Ca2+ Imaging zeigten spontane, neuronale Netzwerkaktivität, die noch weitergehend analysiert werden müssen. Mittels Patch-Clamp Analysen konnten wir zeigen, dass Neurone des Patienten mit Schmerzen leichter erregbar sind als Zellen des Patienten ohne Schmerzen, was einen Hinweis auf die mögliche Beteiligung gestörter Ionenkanäle gibt. Wir konnten zeigen, dass patientenspezifische iPSC geeignet sind um ein neuronales in vitro Krankheitsmodell zu erstellen. Dieses Modell zeigt den typischen molekularen Phänotypen des M. Fabry, spricht auf ERT an und liefert erste Hinweise auf pathologische elektrophysiologische Krankheitsursachen, die zu unterschiedlichen Schmerzphänotypen führen können. Zelluläre Veränderungen durch Gb3 Ablagerungen können nun mittels neuester Mikroskopietechniken anhand der von uns generierten Neurone untersucht werden um ein besseres Verständnis der zugrundeliegenden Pathophysiologie zu bekommen. Zusammenfassend bietet unser System eine neue Möglichkeit den neuronalen Einfluss verschiedener GLA Mutationen auf einer funktionellen und molekularen Ebene zu untersuchen und die Diversität von M. Fabry aufzuschlüsseln. KW - Induzierte pluripotente Stammzelle KW - iPSC KW - disease model KW - fabry disease KW - pain Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-199705 ER - TY - JOUR A1 - Klitsch, Alexander A1 - Evdokimov, Dimitar A1 - Frank, Johanna A1 - Thomas, Dominique A1 - Saffer, Nadine A1 - Meyer zu Altenschildesche, Caren A1 - Sisignano, Marco A1 - Kampik, Daniel A1 - Malik, Rayaz A. A1 - Sommer, Claudia A1 - Üçeyler, Nurcan T1 - Reduced association between dendritic cells and corneal sub‐basal nerve fibers in patients with fibromyalgia syndrome JF - Journal of the Peripheral Nervous System N2 - In our study, we aimed at investigating corneal langerhans cells (LC) in patients with fibromyalgia syndrome (FMS) and small fiber neuropathy (SFN) as potential contributors to corneal small fiber pathology. We enrolled women with FMS (n = 134) and SFN (n = 41) who underwent neurological examination, neurophysiology, prostaglandin analysis in tear fluid, and corneal confocal microscopy (CCM). Data were compared with those of 60 age‐matched female controls. After screening for dry eye disease, corneal LC were counted and sub‐classified as dendritic (dLC) and non‐dendritic (ndLC) cells with or without nerve fiber association. We further analyzed corneal nerve fiber density (CNFD), length (CNFL), and branch density (CNBD). Neurological examination indicated deficits of small fiber function in patients with SFN. Nerve conduction studies were normal in all participants. Dry eye disease was more prevalent in FMS (17%) and SFN (28%) patients than in controls (5%). Tear fluid prostaglandin levels did not differ between FMS patients and controls. While corneal LC density in FMS and SFN patients was not different from controls, there were fewer dLC in association with nerve fibers in FMS and SFN patients than in controls (P < .01 each). Compared to controls, CNFL was lower in FMS and SFN patients (P < .05 each), CNFD was lower only in FMS patients (P < .05), and CNBD was lower only in SFN patients (P < .001). There was no difference in any CCM parameter between patients with and without dry eyes. Our data indicate changes in corneal innervation and LC distribution in FMS and SFN, potentially based on altered LC signaling. KW - corneal confocal microscopy KW - fibromyalgia syndrome KW - Langerhans cells KW - pain KW - small fiber neuropathy Y1 - 2020 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-214150 VL - 25 IS - 1 ER - TY - JOUR A1 - Käthner, Ivo A1 - Eidel, Matthias A1 - Häge, Anne-Sophie A1 - Gram, Annika A1 - Pauli, Paul T1 - Observing physicians acting with different levels of empathy modulates later assessed pain tolerance JF - British Journal of Health Psychology N2 - Objectives The patient–physician relationship is essential for treatment success. Previous studies demonstrated that physicians who behave empathic in their interaction with patients have a positive effect on health outcomes. In this study, we investigated if the mere perception of physicians as empathic/not empathic modulates pain despite an emotionally neutral interaction with the patients. Methods N = 60 women took part in an experimental study that simulated a clinical interaction. In the paradigm, each participant watched two immersive 360° videos via a head-mounted display from a patient’s perspective. The physicians in the videos behaved either empathic or not empathic towards a third person. Importantly, these physicians remained emotionally neutral in the subsequent virtual interaction with the participants. Finally, participants received a controlled, painful pressure stimulus within the narratives of the videos. Results The physicians in the high compared with the low empathy videos were rated as more empathic and more likable, indicating successful experimental manipulation. In spite of later neutral behaviour of physicians, this short observation of physicians’ behaviour towards a third person was sufficient to modulate pain tolerance of the participants. Conclusions The finding of this study that the mere observation of physicians’ behaviour towards a third person modulates pain, despite a neutral direct interaction with the participants, has important clinical implications. Further, the proposed paradigm enables investigating aspects of patient–physician communication that are difficult to examine in a clinical setting. KW - patient–physician relationship KW - empathy KW - psychology KW - pain KW - 360° videos Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-258368 VL - 27 IS - 2 ER -