記述言語：英語   出版者・発行元：Seminars in Arthritis and Rheumatism  

Objectives: To assess how patient characteristics and study design influence the effectiveness of control interventions in hand OA trials. Methods: The study protocol was registered in PROSPERO (CRD42020163473). Two authors independently searched four electronic databases from their inception to December 31, 2019. Randomized and non-randomized controlled hand OA trials were included if pain intensity was assessed using a validated scale. We allocated control groups into one of the following: placebo, add-on treatment, no treatment, or active treatment. The standardized mean differences (d) of pain, as well as subjective function and hand strength, were pooled with 95% confidence intervals (CI) and 90% prediction intervals using random-effects models. Meta-regression and post-hoc subgroup analyses were performed to investigate which factors potentially impacted placebo analgesia and between-study heterogeneity. Results: Thirty-one placebo, 11 add-on, 12 no-treatment, and 10 active-treatment controls were included in meta-analyses. Effective pain relief was observed in placebo (d = −0.50, 95% CI −0.63 to −0.37), add-on (d = −0.35, 95% CI −0.59 to −0.12), and active-treatment (d = −0.92, 95% CI −1.35 to −0.48) groups. In subjective function, these treatments had smaller but beneficial effects; hand strength, contrastingly, was not improved. Placebo effects were larger when flare designs were used (d = −0.96) and more homogeneous when minimum pain thresholds were set (d = −0.46, 90% prediction intervals −0.79 to −0.14). Conclusion: Placebo, add-on, and active control treatments were more effective than the no treatment control in relieving hand pain and improving subjective function. By choosing minimum pain thresholds and flare requirements at patient enrollment, moderate pain relief may be replicated among control participants in future randomized placebo-controlled trials.

DOI： 10.1016/j.semarthrit.2021.04.006

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記述言語：英語   出版者・発行元：IBRO Neuroscience Reports  

Quantitative objective measurement of chronic pain is important. We elucidated chronic pain-related cortical neural activity and neural connectivity among pain-related brain regions in complex regional pain syndrome (CRPS). Resting-state magnetoencephalography recordings were performed. Cortical current density and neural connectivity, revealed by amplitude envelope correlation (AEC), were estimated on standardized brain magnetic resonance imaging. Intra-experiment pain was assessed subjectively using a visual analogue scale (VAS). The correlation between current density and VAS scores was calculated for the occipital areas and pain-related cortices. Current density in the primary (SI) and secondary (SII) somatosensory cortex and precuneus in both hemispheres was negatively correlated with the pain VAS score. The AEC and VAS values were significantly correlated for the SII and the precuneus and for the SII and insular cortex in the alpha frequency band in the right hemisphere. In the theta frequency band, the AEC and VAS values correlated for the SII and posterior cingulate cortex in the right hemisphere. Our results suggested that disruption of pain processes and functions in the default mode network occurs in CRPS. Our method targeting the neural mechanism of pain has the potential to offer a clinically objective means of evaluating it.

DOI： 10.1016/j.ibneur.2021.05.001

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：BMC Musculoskeletal Disorders  

Background: Hand osteoarthritis (OA) has a wide spectrum of clinical presentations and physical function is one of the core domains where patients suffer. The Functional Index for Hand Osteoarthritis (FIHOA) is a leading assessment tool for hand OA-related functional impairment. Our objective was to make a Japanese version of FIHOA (J-FIHOA) and validate it among Japanese hand OA patients. Methods: Forward and backward translation processes were completed to create a culturally adapted J-FIHOA. A prospective, observational multicenter study was undertaken for the validation process. Seventeen collaborating hospitals recruited Japanese hand OA patients who met the American College of Rheumatology criteria. A medical record review and responses to the following patient-rated questionnaires were collected: J-FIHOA, Hand20, Health Assessment Questionnaire (HAQ), numerical rating scale for pain (NRS pain) and Short Form 36 Health Survey (SF-36). We explored the structure of J-FIHOA using factor analysis. Cronbach's alpha coefficients and item-total correlations were calculated. Correlations between J-FIHOA and other questionnaires were evaluated for construct validity. Participants in clinically stable conditions repeated J-FIHOA at a one-to two-week interval to assess test-retest reliability. To evaluate responsiveness, symptomatic patients who started new pharmacological treatments had a 1-month follow-up visit and completed the questionnaires twice. Effect size (ES) and standardized response mean (SRM) were calculated with pre- A nd post-treatment data sets. We assessed responsiveness, comparing ES and SRM of J-FIHOA with other questionnaires (construct approach). Results: A total of 210 patients participated. J-FIHOA had unidimensional structure. Cronbach's alphas (0.914 among females and 0.929 among males) and item-total correlations (range, 0.508 to 0.881) revealed high internal consistency. Hand20, which measures upper extremity disability, was strongly correlated with J-FIHOA (r = 0.82) while the mental and role-social components of SF-36 showed no correlations (r =-0.24 and-0.26, respectively). Intraclass correlation coefficient for test-retest reliability was 0.83 and satisfactory. J-FIHOA showed the highest ES and SRM (-0.68 and-0.62, respectively) among all questionnaires, except for NRS pain. Conclusions: Our results showed J-FIHOA had good measurement properties to assess physical function in Japanese hand OA patients both for ambulatory follow-up in clinical practice, and clinical research and therapeutic trials.

DOI： 10.1186/s12891-020-03193-6

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Neurosurgery  

Background and Importance: Hourglass-like constrictions are fascicular conditions confirmed definitively by interfascicular neurolysis. Certain peripheral nerves have vulnerable areas such as around the elbow in the posterior interosseous nerve. We report the first hourglass-like constriction in the brachial plexus supplying the radial innervated forearm musculature. Preoperative magnetic resonance imaging (MRI) findings of the brachial plexus were consistent with neuralgic amyotrophy (NA). Clinical Presentation: A 9-yr-old boy experienced worsening left arm pain and difficulty in elevating the shoulder. Sequentially, severe palsy emerged when extending the wrist, thumb, and fingers. Based on the clinical picture, we diagnosed him with NA. The oblique coronal T2-weighted short-tau inversion recovery images showed mildly diffuse enlargement and hyperintensity of the brachial plexus. He showed few signs of improvement and interfascicular neurolysis was performed 11 mo after the onset. One of the fascicles in the posterior cord had developed an hourglass-like constriction. Electrical stimulation confirmed that the fascicle supplied forearm muscles. His wrist and finger extension had almost recovered at the 12-mo postoperative visit. Conclusion: Hourglass-like constrictions can occur in the brachial plexus. Although surgical approaches for the constrictions are still controversial, several reports demonstrated their effectiveness. Meanwhile, concerning NA treatment, evidence on the surgical intervention is lacking. Brachial plexus MRI might help in discerning the lesion and planning treatment options including surgical interventions. Hourglass-like constrictions are a possible etiology for certain NA patients with residual symptoms or paresis.

DOI： 10.1093/neuros/nyx171

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