Publications by authors named "Elizabeth R Felix"

57 Publications

Interrelationship of Neurogenic Obesity and Chronic Neuropathic Pain in Persons With Spinal Cord Injury.

Top Spinal Cord Inj Rehabil 2021 ;27(1):75-83

Department of Physical Medicine and Rehabilitation, University of Miami Miller School of Medicine, Miami, Florida.

The prevalence of obesity and of neuropathic pain are both estimated at above 50% in the population of people with chronic spinal cord injury (SCI). These secondary consequences of SCI have significant negative impact on physical functioning, activities of daily living, and quality of life. Investigations of relationships between weight or body composition and chronic neuropathic pain in people with SCI are lacking, but investigations in non-SCI cohorts suggest an association between obesity and the presence and severity of neuropathic pain conditions. In the present article, we present a review of the literature linking obesity and neuropathic pain and summarize findings suggesting that metabolic syndrome and chronic, systemic inflammation due to excess adiposity increase the risk for neuropathic pain after an SCI.
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http://dx.doi.org/10.46292/sci20-00062DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7983640PMC
April 2021

Upper Extremity Overuse Injuries and Obesity After Spinal Cord Injury.

Top Spinal Cord Inj Rehabil 2021 ;27(1):68-74

Department of Physical Medicine and Rehabilitation, University of Miami Miller School of Medicine, Miami, Florida.

Persons with spinal cord injury (SCI) are at high risk for developing neurogenic obesity due to muscle paralysis and obligatory sarcopenia, sympathetic blunting, anabolic deficiency, and blunted satiety. Persons with SCI are also at high risk for shoulder, elbow, wrist, and hand injuries, including neuromusculoskeletal pathologies and nociceptive pain, as human upper extremities are poorly designed to facilitate chronic weight-bearing activities, including manual wheelchair propulsion, transfers, self-care, and day-to-day activities. This article reviews current literature on the relationship between obesity and increased body weight with upper extremity overuse injuries, detailing pathology at the shoulders, elbows, and wrists that elicit pain and functional decline and stressing the importance of weight management to preserve function.
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http://dx.doi.org/10.46292/sci20-00061DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7983631PMC
April 2021

Ocular manifestations and biomarkers of Gulf War Illness in US veterans.

Sci Rep 2021 Mar 22;11(1):6548. Epub 2021 Mar 22.

Ophthalmology, Miami Veterans Affairs Medical Center, Miami, FL, USA.

Gulf War Illness (GWI) is a multisystem disease with variable presentations, making diagnosis difficult. Non-invasive biomarkers would aid in disease diagnosis. We hypothesized that the eye could serve as a biomarker for GWI. We performed a retrospective case-control study using a sample of 1246 patients seen during a 5-month period in an optometry clinic. We identified veterans who were active duty during the Gulf War Era and either had a questionnaire-based diagnosis of GWI (cases) or did not (controls). Medical records were reviewed for eye and medical co-morbidities, medication use, and retinal macular and nerve fiber layer (NFL) thicknesses based on optical coherence tomography (OCT) images. Compared to controls (n = 85), individuals with GWI (n = 60) had a higher frequency of dry eye symptoms (50% vs 32.9%, p = 0.039). Multivariable analysis revealed average retinal NFL thickness (odds ratio; OR = 0.95), cup-to-disc ratio (OR = 0.005), age (OR = 0.82), and PTSD (OR = 20.5) were predictors of a GWI diagnosis. We conclude that GWI is associated with dry eye symptoms and RNFL thinning may serve as a biomarker for disease.
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http://dx.doi.org/10.1038/s41598-021-86061-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7985482PMC
March 2021

Treatments that are perceived to be helpful for non-neuropathic pain after traumatic spinal cord injury: a multicenter cross-sectional survey.

Spinal Cord 2021 Mar 19. Epub 2021 Mar 19.

Department of Physical Medicine and Rehabilitation, University of Miami, Miami, FL, USA.

Study Design: Cross-sectional survey.

Objectives: The objective of the study was to identify the treatments that people with traumatic spinal cord injury (SCI) used for their non-neuropathic pains (nonNeuPs) and how they subjectively rated the helpfulness of those treatments.

Setting: Six centers from the Spinal Cord Injury Model Systems.

Methods: Three hundred ninety one individuals who were at least 1-year post-traumatic SCI were enrolled. A telephone survey was conducted for pharmacologic and non-pharmacologic treatments utilized in the last 12 months for each participant's three worst pains and the perceived helpfulness of each treatment for each pain.

Results: One hundred ninety (49%) participants reported at least one nonNeuP (Spinal Cord Injury Pain Instrument score < 2) in the previous 7 days. NSAIDs/aspirin, acetaminophen, opioids, and cannabinoids were the most commonly used and helpful pharmacologic treatments for overall nonNeuP locations (helpful in 77-89% of treated pains). Body position adjustment, passive exercise, massage, resistive exercise, and heat therapy were reported as the most commonly used non-pharmacological treatments for nonNeuPs. Heat therapy, aerobic exercise, massage, and body position adjustment were the most helpful non-pharmacological treatments for overall nonNeuP locations (helpful in 71-80% of treated pains). Perceived helpfulness of treatments varied by pain locations, which may be due to different mechanisms underlying pains in different locations.

Conclusions: Results of the study may help guide clinicians in selecting pain-specific treatments for nonNeuPs. The self-reported helpfulness of heat therapy, exercise, and massage suggests a possible direction for clinical trials investigating these treatments of nonNeuP while limiting the side effects accompanying pharmacologic treatments.
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http://dx.doi.org/10.1038/s41393-021-00621-9DOI Listing
March 2021

Pain sensitivity and autonomic nervous system parameters as predictors of dry eye symptoms after LASIK.

Ocul Surf 2021 01 21;19:275-281. Epub 2020 Oct 21.

Department of Physical Medicine & Rehabilitation, University of Miami, Miami, FL, USA; Research Service, Miami Veterans Administration Medical Center, Miami, FL, USA.

Purpose: Differences in pain processing and autonomic function among patients have been implicated in the development of chronic pain after surgery. This study was designed to evaluate whether pain and autonomic metrics predict severity of chronic dry eye (DE) symptoms after LASIK, as there is increasing evidence that DE symptoms may be manifestations of persistent post-operative ocular pain.

Methods: Secondary analysis of prospective randomized clinical trial. Patients were treated with either pregabalin or placebo. As no significant differences in DE symptoms were detected by treatment allocation at six months, all participants were grouped together for the present analyses. Subjects were evaluated pre-LASIK with regard to evoked pain sensitivity (utilizing quantitative sensory testing), autonomic metrics and DE and ocular pain symptoms (via validated questionnaires). Measures of DE and ocular pain were assessed post-LASIK, and the Dry Eye Questionnaire 5 (DEQ5) score 6-months after surgery was the primary outcome of interest.

Results: 43 individuals were randomized to pregabalin (n = 21) or placebo (n = 22). 42 completed the 6-month visit. Several baseline autonomic metrics correlated with 6-month post-operative DEQ5 scores, including lower systolic (r -0.37, p = 0.02) and diastolic blood pressure (r -0.32, p = 0.04). Ocular pain at 6 months was also negatively correlated with blood pressure (r -0.31, p = 0.047). The presence of painful aftersensations was a significant predictor of chronic DE symptoms at 6 months (mean DEQ5 scores: 8.0 ± 1.9 versus 5.0 ± 5.0, p = 0.009).

Conclusions: Heightened parasympathetic tone and prolonged pain sensitivity measured prior to surgery predicted greater DE symptom severity 6 months after LASIK.

Trial Registration: NCT02701764.
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http://dx.doi.org/10.1016/j.jtos.2020.10.004DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7867610PMC
January 2021

Corneal Nerve Pathway Function in Individuals with Dry Eye Symptoms.

Ophthalmology 2021 Apr 8;128(4):619-621. Epub 2020 Aug 8.

Department of Anesthesia, University of Miami, Miami, Florida.

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http://dx.doi.org/10.1016/j.ophtha.2020.07.061DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7868519PMC
April 2021

Transcutaneous Electrical Nerve Stimulation for Facial Pain.

Prog Neurol Surg 2020 21;35:35-44. Epub 2020 Jul 21.

Ophthalmology Department, Miami Veterans Affairs Medical Center, Miami, Florida, USA,

Transcutaneous electrical nerve stimulation (TENS) has been used for its analgesic effects for chronic pain, including facial pain. Here, we summarize how the electrical stimulation of branches of the trigeminal nerve via TENS has been utilized to reduce pain resulting from trigeminal neuralgia, temporomandibular joint disorder, migraine and other headache types, and ocular pain sensations. TENS has been used for both short-term (one session) and long-term (multiple sessions) pain control with little to no adverse effects reported by subjects. The results of the summarized studies suggest TENS is an effective non-invasive, non-pharmacologic means of pain control for patients with facial pain conditions.
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http://dx.doi.org/10.1159/000509620DOI Listing
July 2020

The Efficacy, Effectiveness and Safety of 5% Transdermal Lidocaine Patch for Chronic Low Back Pain: A Narrative Review.

PM R 2020 12 7;12(12):1260-1267. Epub 2020 Apr 7.

Department of Physical Medicine and Rehabilitation, University of Miami Miller School of Medicine; Research Service, Miami Veterans Affairs Medical Center, Miami, FL, USA.

Local anesthetics, such as the 5% transdermal lidocaine patch (5LP), have been frequently used in the treatment of musculoskeletal pain, especially chronic low back pain (CLBP). This review compiles the literature available on the efficacy, effectiveness, and safety of 5LP when used for the management of CLBP. A systematic search method revealed seven articles that fit the inclusion criteria. For each study, efficacy, effectiveness, and adverse events data were extracted. We found no randomized controlled trials with substantial evidence to support the use of 5LP in CLBP, despite the presence of nonrandomized noncontrolled trials suggesting its effectiveness for relief of pain. Future randomized controlled trials with clinically useful outcomes are needed to assess the efficacy, effectiveness, and safety of 5LP for CLBP more appropriately.
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http://dx.doi.org/10.1002/pmrj.12366DOI Listing
December 2020

Effects of Home Exercises on Shoulder Pain and Pathology in Chronic Spinal Cord Injury: A Randomized Controlled Trial.

Am J Phys Med Rehabil 2020 06;99(6):504-513

From the South Florida SCI Model System, Department of Physical Medicine & Rehabilitation, University of Miami Miller School of Medicine, Miami, Florida (DDC, ERF, RI); Miami Veterans Administration Medical Center, Miami, Florida (ERF); Department of Physical Medicine & Rehabilitation, University of Alabama at Birmingham, Birmingham, Alabama (RC); and Jackson Memorial Hospital, Miami, Florida (MFO).

Objective: The aims of this study were to replicate findings that a home exercise program intervention improved shoulder pain and function and to assess changes in supraspinatus tendon pathology associated with the home exercise program in persons with chronic spinal cord injury.

Design: The study is a single-blind randomized controlled trial. Individuals with spinal cord injury of at least 1 yr and chronic shoulder pain of moderate or greater average intensity were enrolled. Participants were randomized to a 12-wk home exercise program consisting of strengthening and stretching exercises or to an education-only control group, with immediate postintervention and 4-wk postintervention (16 wks) follow-ups. The main outcome measures were self-report measures of shoulder pain and impairment, the Physical Examination of the Shoulder Scale, quantitative ultrasound metrics of the supraspinatus tendon, and the Ultrasound Shoulder Pathology Rating Scale.

Results: Thirty-two participants were randomized to home exercise program or education-only control condition. The mean ± SD age was 44.8 ± 12.5; 81.3% were male; 65.6% had motor complete paraplegia. Using a per-protocol, within-group analysis method, significant differences were observed between baseline and postintervention for the home exercise program group for the least pain intensity (P = 0.02), number of days with shoulder pain (P = 0.042), Physical Examination of the Shoulder Scale scores (dominant side, P = 0.036; nondominant side, P = 0.008), the Disabilities of the Arm, Shoulder, and Hand (P = 0.028), and the Patient Global Impression of Change (P = 0.015). The education-only control condition group demonstrated significant changes in average unpleasantness of shoulder pain after the intervention period (P = 0.049). Comparisons in changes from baseline between groups showed that the home exercise program group had greater improvements in nondominant-side Physical Examination of the Shoulder Scale scores and global impression of change, whereas the education-only control condition group had greater improvements in depressive symptoms.For quantitative ultrasound measures, no significant changes were found with within-group analyses for the home exercise program group, although the education-only control condition group demonstrated a decrease in tendon width in the nondominant-side supraspinatus tendon (P = 0.036). Comparison of changes between groups suggests that the education-only control condition group had a greater increase in dominant shoulder supraspinatus tendon ultrasound contrast at the end of the study.

Conclusions: Changes in several measures of shoulder pain and function occurred after the home exercise program intervention, although the magnitude of changes was only significantly greater than those of the education-only control condition group for two measures. Significant changes in supraspinatus pathology were not detected with quantitative ultrasound metrics.
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http://dx.doi.org/10.1097/PHM.0000000000001362DOI Listing
June 2020

Effect of non-invasive intranasal neurostimulation on tear volume, dryness and ocular pain.

Br J Ophthalmol 2020 09 12;104(9):1310-1316. Epub 2019 Dec 12.

Ophthalmology, Miami VA Medical Center, Miami, Florida, USA

Purpose: To evaluate the effect of one TrueTear session on change in tear volume and symptoms of dryness and ocular pain.

Methods: Retrospective interventional case series of patients seen in a dry eye clinic. Seventy-five individuals underwent an ocular surface examination and one session of neurostimulation. Outcome measures included objective change in tear volume measured via phenol red test, and subjective change in sensations of dryness and ocular pain measured on a 0-10 Numerical Rating Scale.

Results: The mean age of the 75 individuals was 59±13 years, and the majority were male (73%). Intranasal neurostimulation increased tear volume (mean 13.40±8.00 mm, p<0.0005) and reduced intensities of dryness (mean -2.85±2.79, p<0.0005) and ocular pain (mean -1.48±2.41, p<0.0005 for both). However, these effects were independent of one another as change in symptom report did not correlate with change in tear volume (r=-0.13, p=0.25 for dryness; r=0.07, p=0.56 for pain). In a multivariable model, the strongest predictors for increased tear volume were lower baseline tear volume (standardised beta (β)=-0.50, p<0.0005) and absence of an autoimmune disease (β=-0.36, p=0.001) (R=0.30). The strongest predictors for reduced dryness and pain scores were lower baseline dryness and ocular pain scores. No complications related to neurostimulation were noted.

Conclusion: Intranasal neurostimulation increased tear volume and reduced intensities of dryness and ocular pain, independently of one another.
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http://dx.doi.org/10.1136/bjophthalmol-2019-315065DOI Listing
September 2020

Pregabalin Failed to Prevent Dry Eye Symptoms after Laser-Assisted in Situ Keratomileusis (LASIK) in a Randomized Pilot Study.

J Clin Med 2019 Sep 1;8(9). Epub 2019 Sep 1.

Department of Physical Medicine and Rehabilitation, University of Miami, Miami, FL 33136, USA.

Purpose: Perioperative pregabalin administration has been found to reduce the risk of persistent pain after a variety of surgical procedures. However, this approach has not been tested in relation to eye surgery. As such, the purpose of this study was to evaluate whether perioperative pregabalin can reduce the presence of dry eye (DE) symptoms, including eye pain, six months after laser-assisted in situ keratomileusis (LASIK).

Methods: Prospective, masked, randomized single-center pilot study. Patients were treated with either pregabalin (oral solution of pregabalin 150 mg twice daily, first dose prior to surgery, continued for a total of 28 doses over 14 days) or placebo solution. The primary outcome was dry eye symptoms as measured by the Dry Eye Questionnaire 5 (DEQ-5). Secondary outcome measures included pain-related eye symptoms.

Results: In total, 43 individuals were enrolled in the study and randomized to pregabalin ( = 21) or placebo ( = 22). Of those, 42 individuals completed the final visit after six months of follow-up. Some differences were noted between the two groups at baseline, including a higher frequency of females in the pregabalin group. At 6-months, there were no significant differences in the percentage of patients with DE symptoms (DEQ5 ≥ 6, 57% vs. 33%, = 0.14), DE symptom severity (DEQ5, 6.6 ± 5.0 vs. 4.5 ± 4.2, = 0.14), ocular pain intensity (numerical rating scale, 1.10 ± 1.48 vs. 0.38 ± 0.97, = 0.08), or neuropathic pain complaints (Neuropathic Pain Symptom Inventory-Eye, 2.81 ± 4.07 vs. 3.14 ± 5.85, = 0.83) between the pregabalin and control groups. Ocular signs were likewise similar between the groups, and of note, did not correlate with DE symptoms. The strongest predictor of DE symptoms six months post-surgery was the presence of DE symptoms prior to surgery.

Conclusions: Perioperative pregabalin did not reduce the frequency or severity of DE symptoms at a six month follow-up after LASIK in this small pilot study.
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http://dx.doi.org/10.3390/jcm8091355DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6780750PMC
September 2019

Dysfunctional Coping Mechanisms Contribute to Dry Eye Symptoms.

J Clin Med 2019 Jun 24;8(6). Epub 2019 Jun 24.

Ophthalmology and Research Services, Miami Veterans Affairs (VA) Medical Center, Miami, FL 33125, USA.

Dysfunctional coping behaviors, such as catastrophizing, have been implicated in pain severity and chronicity across several pain disorders. However, the impact of dysfunctional coping has not been examined under the context of dry eye (DE). This study evaluates relationships between catastrophizing and measures of DE, including pain severity and pain-related daily interference. The population consisted of patients seen at Miami Veterans Affairs eye clinic between April 2016 and October 2017. Patients filled out standardized questionnaires assessing symptoms of DE and eye pain, non-ocular pain, mental health, coping behaviors (Pain Catastrophizing Scale, PCS), and pain-related daily interference as a perceived impact on quality of life (Multidimensional Pain Inventory, Interference Subscale, MPI-Interference), and all patients underwent an ocular surface examination. In total, 194 patients participated, with a mean age of 58.8 ± 9.6 years, the majority being male, non-Hispanic, and black. PCS (catastrophizing) was correlated with DE symptom severity, including Dry-Eye Questionnaire 5 (DEQ5; r = 0.41, < 0.0005), Ocular Surface Disease Index (OSDI; r = 0.40, < 0.0005), and neuropathic-like eye pain (Neuropathic Pain Symptom Inventory-Eye (NPSI-Eye; r = 0.48, < 0.0005). Most tear metrics, on the other hand, did not correlate with PCS. Linear regressions showed that PCS, non-ocular pain intensity, and number of pain conditions were significant predictors of DEQ5 (overall DE symptoms), while PCS and non-ocular pain intensity were predictors of NPSI-Eye scores, as were insomnia scores and analgesic use. In a separate analysis, PCS and DE symptoms (OSDI) associated with pain-related interference (MPI-Interference) along with non-ocular pain intensity, post-traumatic stress disorder (PTSD), number of pain conditions, and non-Hispanic ethnicity. These findings suggest that catastrophizing is not significantly related to signs of DE, but is strongly associated to pain-related symptoms of DE and daily interference due to pain.
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http://dx.doi.org/10.3390/jcm8060901DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6617174PMC
June 2019

Oral Gabapentinoids and Nerve Blocks for the Treatment of Chronic Ocular Pain.

Eye Contact Lens 2020 May;46(3):174-181

Department of Ophthalmology (L.R.S., A.G., E.R.F., R.C.L., C.D.S.), Bascom Palmer Eye Institute, University of Miami, Miami, FL; Ophthalmology, Miami Veterans Administration Medical Center (A.G.), Miami, FL; Physical Medicine and Rehabilitation (E.R.F.), University of Miami, Miami, FL; Department of Anesthesiology, Perioperative Medicine and Pain Management (D.B.H., R.C.L., C.D.S.), University of Miami Miller School of Medicine, Miami, FL; John P. Hussman Institute for Human Genomics (R.C.L.), University of Miami Miller School of Medicine, Miami, FL; and John T Macdonald Foundation Department of Human Genetics (R.C.L.), University of Miami Miller School of Medicine, Miami, FL.

Purpose: There is a recognition that nerve dysfunction can contribute to chronic ocular pain in some individuals. However, limited data are available on how to treat individuals with a presumed neuropathic component to their ocular pain. As such, the purpose of this study was to examine the efficacy of our treatment approaches to this entity.

Methods: A retrospective review of treatments and outcomes in individuals with chronic ocular pain that failed traditional therapies.

Results: We started eight patients on an oral gabapentinoid (gabapentin and/or pregabalin) as part of their pain regimen (mean age 46 years, 50% women). Two individuals reported complete ocular pain relief with a gabapentinoid, in conjunction with their topical and oral medication regimen. Three individuals noted significant improvements, one slight improvement, and two others no improvement in ocular pain with gabapentin or pregabalin. We performed periocular nerve blocks (4 mL of 0.5% bupivacaine mixed with 1 mL of 80 mg/mL methylprednisolone acetate) targeting the periocular nerves (supraorbital, supratrochlear, infratrochlear, and infraorbital) in 11 individuals (mean age 54 years, 36% women), 10 of whom had previously used a gabapentinoid without ocular pain improvement. Seven individuals experienced pain relief after nerve blocks that lasted from hours to months and four failed to benefit. Five of the individuals who experienced pain relief underwent repeat nerve blocks, weeks to months later.

Conclusions: Approaches used to treat chronic pain outside the eye can be applied to ocular pain that is not responsive to traditional therapies.
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http://dx.doi.org/10.1097/ICL.0000000000000630DOI Listing
May 2020

Individuals with migraine have a different dry eye symptom profile than individuals without migraine.

Br J Ophthalmol 2020 02 30;104(2):260-264. Epub 2019 Apr 30.

Bascom Palmer Eye Institute, University of Miami, Miami, Florida, USA

Background: Many individuals with migraine report symptoms of dry eye (DE). However, it is not known whether DE profiles are similar between individuals with and without migraine. To bridge this gap, we evaluated symptoms and signs of DE, including symptoms suggestive of nerve dysfunction, in a large group of individuals with DE symptoms, and compared profiles between individuals with migraine and those without migraine or headache.

Methods: Prospective cross-sectional study of individuals with DE symptoms seen at the Miami VA.

Results: Of 250 individuals, 31 met International Classification of Headache Disorders criteria for migraine based on a validated screen. Individuals with migraine were significantly younger (57 vs 62 years) and more likely to be female (26% vs 6%) than controls. Individuals with migraine had more severe DE symptoms and ocular pain compared with controls (mean Ocular Surface Disease Index 53.93 ± 21.76 vs 36.30 ± 22.90, p=0.0001; mean Neuropathic Pain Symptom Inventory modified for the Eye 39.39 ± 23.33 vs 21.86 ± 20.17, p=0.0001). The difference in symptom profile occurred despite similar ocular surface parameters between the groups.

Conclusions: Individuals with migraine had a different DE symptom yet a similar DE sign profile when compared with controls without migraine. This suggests that DE symptoms in individuals with migraine may be driven by nerve dysfunction as opposed to ocular surface abnormalities.
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http://dx.doi.org/10.1136/bjophthalmol-2018-313471DOI Listing
February 2020

Outcome prediction from post-injury resilience in patients with TBI.

Rehabil Psychol 2019 Aug 11;64(3):320-327. Epub 2019 Apr 11.

Department of Physical Medicine and Rehabilitation.

Purpose/objective: The objective of the study was to evaluate the extent to which 1- and 2-year outcomes after traumatic brain injury (TBI) are predicted by resilience. Research Method/Design: This was an observational, longitudinal study of persons ( = 158) with moderate or severe TBI who completed both 1- and 2-year outcome assessments. Outcomes included anxiety (Generalized Anxiety Disorder-7), depression (Patient Health Questionnaire-9), life satisfaction (Satisfaction with Life Scale), substance misuse, and return-to-work measures. The Connor-Davidson Resilience Scale was used to assess resilience at 3 or 6 months after injury.

Results: Greater resilience predicted less anxiety, depression, and substance use and better satisfaction with life and return to work at 1 year after injury for both adjusted and unadjusted models. Standardized regression coefficients were all greater than 0.38 for continuous outcomes, whereas odds ratios were 1.34 and 0.81 for the return to work and substance misuse outcomes, respectively ( < .05). Similar but weaker trends were found at 2 years after injury, with statistical significance no longer met for all outcomes.

Conclusions/implications: Resilience was shown to have predictive ability for outcomes at 1 and 2 years after TBI. Resilience appears to be a salient and important variable for long-term outcomes in person with TBI after adjusting for injury and demographic characteristics. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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http://dx.doi.org/10.1037/rep0000263DOI Listing
August 2019

Modification of the Neuropathic Pain Symptom Inventory for use in eye pain (NPSI-Eye).

Pain 2019 07;160(7):1541-1550

Miami Veterans Administration Medical Center, Miami, FL, United States.

Chronic eye pain, which has previously been assumed to be due to ocular surface abnormalities (ie, "dry eye [DE] disease"), has recently garnered attention as a potential indicator of neuropathic ocular pain in some patients. The purpose of this study was to evaluate the psychometric properties of a modified version of the Neuropathic Pain Symptom Inventory in individuals with eye pain (NPSI-Eye). Enrolled participants (n = 397) completed the NPSI-Eye, general pain severity questionnaires, DE symptom report, and psychological health indices. Participants also underwent mechanical pain sensitivity testing of the cornea, tear film assessment, and evaluation of the efficacy of anesthetic eye drops to relieve pain. Short-term test-retest reliability of the NPSI-Eye was excellent (intraclass correlation coefficient = 0.98, P < 0.001). Correlations between the NPSI-Eye and indicators of general eye pain were ≥0.65 (P < 0.001), whereas correlations between the NPSI-Eye and DE symptom severity and psychological health indices were lower (rho = 0.56, 0.32, 0.37; all P < 0.001). Individuals who reported little or no decrease in pain after anesthetic eye drops (hypothesized to indicate eye pain with at least partial central involvement) had significantly higher NPSI-Eye scores than participants whose eye pain was completely relieved by anesthetic (P < 0.05). Overall, our results support preliminary validation of the NPSI-Eye, yielding similar metrics to those reported in Bouhassira et al.'s original NPSI publication (2004). However, additional evaluation and refinement of some questions may be desirable, including the potential elimination of items that were not highly endorsed.
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http://dx.doi.org/10.1097/j.pain.0000000000001552DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6586475PMC
July 2019

Photophobia and sensations of dryness in patients with migraine occur independent of baseline tear volume and improve following botulinum toxin A injections.

Br J Ophthalmol 2019 08 29;103(8):1024-1029. Epub 2018 Sep 29.

Miami Veterans Administration Medical Center, Miami, Florida, USA

Background: To evaluate the efficacy of botulinum toxin A (BoNT-A) in reducing photophobia and dry eye symptoms in individuals with chronic migraine. Additionally, we aimed to evaluate tear film volume as a potential contributor to symptoms in these patients.

Methods: Retrospective review of 76 patients who received BoNT-A for chronic migraine between 23 August 2017 and 13 December 2017 at the Miami Veterans Affairs Medical Center Neurotoxin Clinic. Demographic data and all comorbidities were queried via chart review. Standardised validated surveys were administered to assess symptoms prior to and after BoNT-A injection. Preinjection tear volumes were obtained using the phenol red thread (PRT) test.

Results: Preinjection migraine, photophobia and dry eye symptom scores were all significantly correlated, p<0.05, and none were associated with preinjection PRT results. After BoNT-A, improvements in migraine, photophobia and dry eye symptoms were also significantly correlated, p<0.05 and similarly did not associate with preinjection PRT results. Photophobia scores significantly improved following BoNT-A, while dry eye symptoms significantly improved in those with severe symptoms at baseline (DEQ-5 score ≥12), p=0.027. In logistic regression analysis of all individuals with dry eye symptoms (DEQ-5 ≥6), individuals with more severe dry eye symptoms were more likely improve, OR 1.27, 95% CI 1.06 to 1.51, p<0.01.

Conclusions: BoNT-A significantly improved photophobia in patients being treated for migraine and also improved dry eye symptoms in patients with severe symptoms at baseline, independent of baseline tear film volume. These improvements may be due to modulation of shared trigeminal neural pathways.
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http://dx.doi.org/10.1136/bjophthalmol-2018-312649DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6440864PMC
August 2019

Obesity and Overweight Problems Among Individuals 1 to 25 Years Following Acute Rehabilitation for Traumatic Brain Injury: A NIDILRR Traumatic Brain Injury Model Systems Study.

J Head Trauma Rehabil 2018 Jul/Aug;33(4):246-256

Departments of Ophthalmology and Physical Medicine & Rehabilitation; The University of Alabama at Birmingham, UAB Traumatic Brain Injury Model System (Dr Dreer); Research Department, Craig Hospital, Englewood, Colorado (Dr Ketchum); Traumatic Brain Injury Model Systems National Data and Statistical Center, Englewood, Colorado (Dr Ketchum); Department of Physical Medicine and Rehabilitation, The University of Alabama at Birmingham (Dr Novack); Department of Physical Medicine and Rehabilitation, The Ohio State University, Columbus (Drs Bogner and Corrigan); Department of Physical Medicine and Rehabilitation, University of Miami Miller School of Medicine, Miami, Florida (Drs Felix and Johnson-Greene); Research Service, Bruce W. Carter Department of Veterans Affairs Medical Center, Miami, Florida (Dr Felix); and Department of Physical Medicine and Rehabilitation, Indiana University School of Medicine, Rehabilitation Hospital of Indiana, Indianapolis (Dr Hammond).

Objective: Examine the prevalence of weight classifications and factors related to obesity/overweight among persons 1 to 25 years following traumatic brain injury (TBI) using the Traumatic Brain Injury Model Systems national database.

Design: Multicenter, cross-sectional, observational design.

Setting: Traumatic Brain Injury Model Systems inpatient rehabilitation facilities.

Participants: Persons (N = 7287) 1, 2, 5, 10, 15, 20, or 25 years after TBI who required inpatient acute rehabilitation.

Main Outcome Measures: Body mass index, demographic characteristics, functional, health, satisfaction with life, and global outcomes.

Results: Overall postinjury weight prevalence rates were 23% obese, 36% overweight, 39% normal, and 3% underweight. Higher rates for obesity and overweight problems were associated with increasing time since injury. Younger (18-19 years) and older (80+ years) age, those in a vegetative state, and those reporting excellent health were less likely to be obese. Individuals with a history of hypertension, heart failure, or diabetes were more likely to be obese.

Conclusions: Being obese or overweight presents a health risk in the years following rehabilitation for TBI. The findings support the need for longitudinal studies and highlight the advisability of monitoring weight and promoting healthy lifestyle behaviors over time in survivors of TBI.
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http://dx.doi.org/10.1097/HTR.0000000000000408DOI Listing
August 2019

Race/Ethnicity and Retention in Traumatic Brain Injury Outcomes Research: A Traumatic Brain Injury Model Systems National Database Study.

J Head Trauma Rehabil 2018 Jul/Aug;33(4):219-227

Departments of Physical Medicine and Rehabilitation and Psychiatry, Baylor College of Medicine/Harris Health System and Brain Injury Research Center, TIRR Memorial Hermann, Houston, Texas (Dr Sander); Kessler Foundation and Rutgers, New Jersey Medical School, West Orange (Dr Lequerica); Craig Hospital, Englewood, Colorado (Dr Ketchum); Department of Physical Medicine and Rehabilitation, Indiana University School of Medicine, Indianapolis (Dr Hammond); Departments of Physical Medicine and Rehabilitation/Neuropsychology and Occupational Therapy, Virginia Commonwealth University, Richmond (Dr Gary); Division of Rehabilitation Sciences, University of Texas Medical Branch, Galveston, and Brain Injury Research Center, TIRR Memorial Hermann, Houston, Texas (Dr Pappadis); University of Miami Miller School of Medicine, Miami, Florida (Drs Felix and Johnson-Greene); and Rusk Rehabilitation, New York University Langone School of Medicine, New York (Dr Bushnik).

Objective: To investigate the contribution of race/ethnicity to retention in traumatic brain injury (TBI) research at 1 to 2 years postinjury.

Setting: Community.

Participants: With dates of injury between October 1, 2002, and March 31, 2013, 5548 whites, 1347 blacks, and 790 Hispanics enrolled in the Traumatic Brain Injury Model Systems National Database.

Design: Retrospective database analysis.

Main Measure: Retention, defined as completion of at least 1 question on the follow-up interview by the person with TBI or a proxy.

Results: Retention rates 1 to 2 years post-TBI were significantly lower for Hispanic (85.2%) than for white (91.8%) or black participants (90.5%) and depended significantly on history of problem drug or alcohol use. Other variables associated with low retention included older age, lower education, violent cause of injury, and discharge to an institution versus private residence.

Conclusions: The findings emphasize the importance of investigating retention rates separately for blacks and Hispanics rather than combining them or grouping either with other races or ethnicities. The results also suggest the need for implementing procedures to increase retention of Hispanics in longitudinal TBI research.
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http://dx.doi.org/10.1097/HTR.0000000000000395DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6611457PMC
August 2019

The Feasibility of Telephone-Administered Cognitive Testing in Individuals 1 and 2 Years after Inpatient Rehabilitation for Traumatic Brain Injury.

J Neurotrauma 2018 05 13;35(10):1138-1145. Epub 2018 Mar 13.

13 Craig Hospital , Englewood, Colorado.

Traumatic brain injury (TBI) often results in cognitive impairment, and trajectories of cognitive functioning can vary tremendously over time across survivors. Traditional approaches to measuring cognitive performance require face-to-face administration of a battery of objective neuropsychological tests, which can be time- and labor-intensive. There are numerous clinical and research contexts in which in-person testing is undesirable or unfeasible, including clinical monitoring of older adults or individuals with disability for whom travel is challenging, and epidemiological studies of geographically dispersed participants. A telephone-based method for measuring cognition could conserve resources and improve efficiency. The objective of this study is to examine the feasibility and usefulness of the Brief Test of Adult Cognition by Telephone (BTACT) among individuals who are 1 and 2 years post-moderate-to-severe TBI. A total of 463 individuals participated in the study at Year 1 post-injury, and 386 participated at Year 2. The sample was mostly male (73%) and white (59%), with an average age of (mean ± standard deviation) 47.9 ± 20.9 years, and 73% experienced a duration of post-traumatic amnesia (PTA) greater than 7 days. A majority of participants were able to complete the BTACT subtests (61-69% and 56-64% for Years 1 and 2 respectively); score imputation for those unable to complete a test due to severity of cognitive impairment yields complete data for 74-79% of the sample. BTACT subtests showed expected changes between Years 1-2, and summary scores demonstrated expected associations with injury severity, employment status, and cognitive status as measured by the Functional Independence Measure. Results indicate it is feasible, efficient, and useful to measure cognition over the telephone among individuals with moderate-severe TBI.
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http://dx.doi.org/10.1089/neu.2017.5347DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6421998PMC
May 2018

Evidence that dry eye is a comorbid pain condition in a U.S. veteran population.

Pain Rep 2017 Nov 20;2(6):e629. Epub 2017 Nov 20.

Miami Veterans Administration Medical Center, Miami, FL, USA.

Introduction: Recent evidence suggests that dry eye (DE) may be comorbid with other chronic pain conditions.

Objectives: To evaluate DE as a comorbid condition in the U.S. veteran population.

Methods: Retrospective review of veterans seen in the Veterans Administration Healthcare System (Veteran Affairs) between January 1, 2010, and December 31, 2014. Dry eye and nonocular pain disorders were ascertained by codes. Dry eye was further separated into codes representing tear film dysfunction or ocular pain. χ and logistic regression analyses were used to examine frequency and risk of DE, ocular pain, and tear film dysfunction by pain disorders.

Results: Of 3,265,894 veterans, 959,881 had a DE diagnosis (29.4%). Dry eye frequency increased with the number of pain conditions reported ( < 0.0005). Ocular pain was most strongly associated with headache (odds ratio [OR] 2.98; 95% confidence interval [CI] 2.95-3.01), tension headache (OR 2.64; 95% CI 2.58-2.71), migraine (OR 2.58; 95% CI 2.54-2.61), temporomandibular joint dysfunction (OR 2.39; 95% CI 2.34-2.44), pelvic pain (OR 2.30; 95% CI 2.24-2.37), central pain syndrome (OR 2.24; 95% CI 1.94-2.60), and fibromyalgia/muscle pain (OR 2.23; 95% CI 2.20-2.26), all < 0.0005. Tear film dysfunction was most closely associated with osteoarthritis (OR 1.97; 95% CI 1.96-1.98) and postherpetic neuralgia (OR 1.95; 95% CI 1.90-2.00), both < 0.0005.

Conclusions: Dry eye, including both ocular pain and tear film dysfunction, is comorbid with pain conditions in this nationwide population, implying common mechanisms.
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http://dx.doi.org/10.1097/PR9.0000000000000629DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5741329PMC
November 2017

Neuropathic pain and dry eye.

Ocul Surf 2018 01 12;16(1):31-44. Epub 2017 Oct 12.

Department of Anesthesiology, Perioperative Medicine and Pain Management, University of Miami Miller School of Medicine, Miami, FL, USA; John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, FL, USA; John T Macdonald Foundation Department of Human Genetics, University of Miami Miller School of Medicine, Miami, FL, USA.

Dry eye is a common, multifactorial disease currently diagnosed by a combination of symptoms and signs. Its epidemiology and clinical presentation have many similarities with neuropathic pain outside the eye. This review highlights the similarities between dry eye and neuropathic pain, focusing on clinical features, somatosensory function, and underlying pathophysiology. Implications of these similarities on the diagnosis and treatment of dry eye are discussed.
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http://dx.doi.org/10.1016/j.jtos.2017.10.001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5756672PMC
January 2018

Increased Reliability of Quantitative Ultrasound Measures of the Supraspinatus Tendon Using Multiple Image Analysts and Analysis Runs.

Am J Phys Med Rehabil 2018 Jan;97(1):62-67

From the Department of Physical Medicine & Rehabilitation, University of Miami Miller School of Medicine, Miami, Florida (ERF, TSC, DDC, RWI); Research Service, Miami VA Healthcare System, Miami, Florida (ERF); and Department of Neurological Surgery, Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, Florida (REC).

Quantitative ultrasound (QUS) is an inexpensive and promising tool for sensitive measurement of tendon pathology. However, few studies have reported the psychometric properties of measurements obtained using this technique for assessments of the supraspinatus tendon. The present study was undertaken to determine the variance contributed by several sources of error (participant, ultrasound operator, image analyst, analysis session) to QUS measures of the supraspinatus tendon. Transverse images of the supraspinatus tendon were captured from eleven subjects (22 shoulders) by two ultrasonographers, and each image was analyzed by two image analysts who each completed two analysis runs. Generalizability theory and intraclass correlations were used to assess the reliability of seven QUS metrics. Measures of tendon/cartilage thickness demonstrated the greatest degree of overall dependability (ϕ = 0.84), followed by echogenicity (ϕ = 0.56), variance (ϕ = 0.55), and entropy (ϕ = 0.47), suggesting that these measures of the supraspinatus tendon may be promising metrics for assessing differences in tendon health. Interrater reliability between ultrasound operators ranged from low to moderate for different QUS metrics, but using more than one image analyst and performing repeated measurement analysis runs on each image help increase reliability of QUS measures for the supraspinatus tendon.
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http://dx.doi.org/10.1097/PHM.0000000000000820DOI Listing
January 2018

Traumatic brain injury, dry eye and comorbid pain diagnoses in US veterans.

Br J Ophthalmol 2018 05 26;102(5):667-673. Epub 2017 Aug 26.

Department of Ophthalmology, Miami VA Medical Center, Miami, Florida, USA.

Aims: The purpose of the study is to evaluate the relationship between dry eye (DE) and pain diagnoses in US veterans with and without traumatic brain injury (TBI).

Methods: Retrospective cohort study of veterans who were seen in the Veterans Administration Hospital (VA) between 1 January 2010 and 31 December 2014. Veterans were separated into two groups by the presence or absence of an International Classification of Diseases, Ninth Revision diagnosis of TBI and assessed for DE and other comorbidities. A dendrogram was used to investigate the linkage between TBI, DE, chronic pain and other comorbid conditions.

Results: Of the 3 265 894 veterans seen during the 5-year period, 3.97% carried a diagnosis of TBI. Veterans with TBI were more likely to have a diagnosis of DE compared with their counterparts without TBI (37.2% vs 29.1%, p<0.0005). The association was stronger between TBI and ocular pain (OR 3.08; 95% CI 3.03 to 3.13) compared with tear film dysfunction (OR 1.09; 95% CI 1.07 to 1.10). Those with TBI were also about twice as likely to have a diagnosis of chronic pain, headache, depression or post-traumatic stress disorder compared with their counterparts without TBI. Cluster analysis of TBI, DE and pain diagnoses of interest revealed that central pain syndrome, cluster headache, sicca syndrome, keratoconjunctivitis sicca and late effect of injury to the nervous system (as can be seen after TBI) were all closely clustered together.

Conclusions: DE and pain disorders occur at higher frequencies in patients with a diagnosis of TBI, suggesting a common underlying pathophysiology.
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http://dx.doi.org/10.1136/bjophthalmol-2017-310509DOI Listing
May 2018

Epidemiology of discordance between symptoms and signs of dry eye.

Br J Ophthalmol 2018 05 18;102(5):674-679. Epub 2017 Aug 18.

Miami Veterans Administration Medical Center, Miami, Florida, USA.

Background/aims: The frequent lack of association between dry eye (DE) symptoms and signs leads to challenges in diagnosing and assessing the disease.

Methods: Participants underwent ocular surface examinations to evaluate signs of disease and completed questionnaires to assess ocular symptoms, psychological status and medication use. To assess nociceptive system integrity, quantitative sensory testing (QST), including vibratory and thermal threshold measures and temporal summation of pain were obtained at the forearm and forehead. Correlations between DE discordance score (degree of discrepancy between symptom severity and DE signs) and patient characteristics were determined. Higher discordance scores indicated more symptoms than signs.

Results: 326 patients participated (mean age: 62 years; SD: 10 years; 92% men). Age was negatively correlated with DE discordance score (Pearson r=-0.30, p<0.0005), while mental health indices were positively correlated. Chronic pain elsewhere in the body (ie, non-ocular pain conditions) and intensity ratings of prolonged aftersensations of pain evoked by noxious hot and cold stimuli were also significantly correlated with DE discordance score. Multiple linear regression demonstrated that post-traumatic stress disorder and non-ocular pain intensity were important predictors of DE discordance score, Dry Eye Questionnaire-5 and Ocular Surface Disease Index and that DE discordance was also sensitive to QST as well.

Conclusions: The present study provides evidence that the degree of discordance between DE symptom report and measurable signs of ocular surface disease is associated with comorbidities related to clinical pain and to hyperalgesia as demonstrated with QST. Understanding the epidemiology of DE discordance can aid in interpreting the DE exam and individualising treatment.
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http://dx.doi.org/10.1136/bjophthalmol-2017-310633DOI Listing
May 2018

Evidence that Dry Eye Represents a Chronic Overlapping Pain Condition.

Mol Pain 2017 Jan-Dec;13:1744806917729306

John P. Hussman Institute for Human Genomics, University of Miami, Miller School of Medicine, Miami, FL 7John T. Macdonald Foundation.

Abstract: Recent data suggest that corneal somatosensory dysfunction may be the underlying cause of severe dry eye symptoms in the absence of ocular surface pathology seen in a subset of patients diagnosed with “dry eye syndrome.” This subset of patients tends to demonstrate a unique constellation of symptoms that are persistent, more severe, and generally respond poorly to current dry eye therapies targeting inadequate or dysfunctional tears. A growing body of literature suggests that symptoms in these patients may be better characterized as neuropathic ocular pain rather than dry eye. In these patients, dry eye symptoms are often associated with numerous comorbid pain conditions and evidence of central pain processing abnormalities, where eye pain is just one of multiple overlapping peripheral manifestations. In this review, we discuss the concept and potential mechanisms of chronic overlapping pain conditions as well as evidence for considering neuropathic ocular pain as one of these overlapping pain conditions.
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http://dx.doi.org/10.1177/1744806917729306DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5584655PMC
September 2018

Longitudinal Examination of Resilience After Traumatic Brain Injury: A Traumatic Brain Injury Model Systems Study.

Arch Phys Med Rehabil 2018 02 20;99(2):264-271. Epub 2017 Jul 20.

Department of Physical Medicine and Rehabilitation, University of Miami Miller School of Medicine, Miami, FL.

Objectives: To evaluate (1) the trajectory of resilience during the first year after a moderate-severe traumatic brain injury (TBI); (2) factors associated with resilience at 3, 6, and 12 months postinjury; and (3) changing relationships over time between resilience and other factors.

Design: Longitudinal analysis of an observational cohort.

Setting: Five inpatient rehabilitation centers.

Participants: Patients with TBI (N=195) enrolled in the resilience module of the TBI Model Systems study with data collected at 3-, 6-, and 12-month follow-up.

Interventions: Not applicable.

Main Outcome Measure: Connor-Davidson Resilience Scale.

Results: Initially, resilience levels appeared to be stable during the first year postinjury. Individual growth curve models were used to examine resilience over time in relation to demographic, psychosocial, and injury characteristics. After adjusting for these characteristics, resilience actually declined over time. Higher levels of resilience were related to nonminority status, absence of preinjury substance abuse, lower anxiety and disability level, and greater life satisfaction.

Conclusions: Resilience is a construct that is relevant to understanding brain injury outcomes and has potential value in planning clinical interventions.
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http://dx.doi.org/10.1016/j.apmr.2017.06.013DOI Listing
February 2018

The Association of Dry Eye Symptom Severity and Comorbid Insomnia in US Veterans.

Eye Contact Lens 2018 Sep;44 Suppl 1:S118-S124

Research Services (A.G., B.E.S., J.J.P., A.L.M., E.R.F., R.C.L., C.S., D.M.W.), Miami Veterans Administration Medical Center, Miami, FL; Department of Ophthalmology (A.G., W.F.), Bascom Palmer Eye Institute, University of Miami, Miami, FL; Department of Physical Medicine and Rehabilitation (E.R.F.), University of Miami Miller School of Medicine, Miami, FL; Department of Anesthesiology (R.C.L., C.S.), Perioperative Medicine and Pain Management, University of Miami Miller School of Medicine, Miami, FL; John P. Hussman Institute for Human Genomics (R.C.L.), University of Miami Miller School of Medicine, Miami, FL; John T Macdonald Foundation Department of Human Genetics (R.C.L.), University of Miami Miller School of Medicine, Miami, FL; and Department of Neurology (D.M.W.), University of Miami Miller School of Medicine, Miami, FL.

Purpose: To investigate the association between dry eye (DE) and insomnia symptom severity.

Methods: Cross-sectional study of 187 individuals seen in the Miami Veterans Affairs eye clinic. An evaluation was performed consisting of questionnaires regarding insomnia (insomnia severity index [ISI]) and DE symptoms, including ocular pain, followed by a comprehensive ocular surface examination. Using a two-step cluster analysis based on intensity ratings of ocular pain, the patient population was divided into two groups (high and low ocular pain groups: HOP and LOP). A control group was ascertained at the same time from the same clinic as defined by no symptoms of DE (Dry Eye Questionnaire 5 [DEQ5], <6). The main outcome measure was the frequency of moderate or greater insomnia in the DE groups.

Results: The mean age of the study sample was 63 years, and 93% were male. All insomnia complaints were rated higher in the HOP group compared with the LOP and control groups (P<0.0005). Most (61%) individuals in the HOP group experienced insomnia of at least moderate severity (ISI≥15) compared with the LOP (41%) and control groups (18%) (P<0.0005). Black race (odds ratio [OR], 2.7; 95% confidence interval [CI], 1.2-6.0; P=0.02), depression severity (OR, 1.2; 95% CI, 1.1-1.3; P<0.0005), and DE symptom severity (DEQ5; OR, 1.1; 95% CI, 1.01-1.2; P=0.03) were significantly associated with clinical insomnia (ISI≥15) after controlling for potential confounders.

Conclusions: After adjusting for demographics and medical comorbidities, we show that DE symptom severity is positively associated with insomnia severity.
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http://dx.doi.org/10.1097/ICL.0000000000000349DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5500440PMC
September 2018

Evidence of central sensitisation in those with dry eye symptoms and neuropathic-like ocular pain complaints: incomplete response to topical anaesthesia and generalised heightened sensitivity to evoked pain.

Br J Ophthalmol 2017 09 18;101(9):1238-1243. Epub 2017 Jan 18.

Miami Veterans Administration Medical Center, Miami, Florida, USA.

Objective: To evaluate how closely neuropathic-like ocular pain (NOP) symptoms align with a metric of central sensitisation (ie, the presence of persistent ocular pain after topical anaesthetic placement) in individuals with dry eye (DE) symptoms.

Design: Cross-sectional study of 224 individuals with DE symptoms seen in the Miami Veterans Affairs eye clinic. An evaluation was performed consisting of questionnaires regarding DE symptoms, NOP descriptors and evoked pain sensitivity testing on the forehead and forearm, followed by a comprehensive ocular surface examination including corneal mechanical sensitivity testing. Subsequent analyses were performed to examine for differences between those with and without ocular pain after topical anaesthetic placement.

Results: The mean age was 62 years with 91% being men. DE symptoms and NOP symptoms were higher in subjects with persistent ocular pain after anaesthesia. Most DE signs were not related to persistent pain, with the exception of meibum quality. Individuals with persistent ocular pain also demonstrated greater sensitivity to evoked pain at testing sites on the forehead and forearm. When examining receiver operator characteristic curves considering persistent pain as a gold standard for central sensitisation within the corneal pathway, intensity of ocular pain ratings, Ocular Surface Disease Index scores and sensitivity to light provided the most robust relationships, each with an area under the curve of 0.72.

Conclusions: Individuals with DE symptoms and persistent ocular pain after topical proparacaine (a marker of central sensitisation to pain) more frequently report NOP-like symptoms and demonstrate increased sensitivity to evoked pain.
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http://dx.doi.org/10.1136/bjophthalmol-2016-309658DOI Listing
September 2017

Epidemiology of Comorbid Conditions Among Adults 50 Years and Older With Traumatic Brain Injury.

J Head Trauma Rehabil 2018 Jan/Feb;33(1):15-24

University of Pittsburgh Department of Physical Medicine and Rehabilitation, Pittsburgh, Pennsylvania (Messrs Kumar and Wang and Drs Juengst, Arenth, and Wagner); University of Pittsburgh Department of Epidemiology, Pittsburgh, Pennsylvania (Messrs Kumar and Wang); Icahn School of Medicine at Mount Sinai, New York, NY (Dr Dams-O'Connor); University of Washington Department of Rehabilitation Medicine, Seattle (Dr Dikmen); Northeastern University Department of Communication Sciences and Disorders, Boston, Massachusetts (Dr O'Neil-Pirozzi); Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts (Dr O'Neil-Pirozzi); Baylor Scott & White Health Medical Center - Plano, TX; Baylor Institute for Rehabilitation, Dallas, TX (Dr Dahdah); Indiana University School of Medicine Department of Physical Medicine and Rehabilitation, Indianapolis, Indiana (Dr Hammond); University of Miami Department of Physical Medicine and Rehabilitation, Miami, Florida (Dr Felix); and University of Pittsburgh Center for Neuroscience, University of Pittsburgh Safar Center for Resuscitation Research, and University of Pittsburgh Department of Neuroscience, Pittsburgh, Pennsylvania (Dr Wagner).

Objectives: Aging individuals with traumatic brain injury (TBI) experience multiple comorbidities that can affect recovery from injury. The objective of this study was to describe the most commonly co-occurring comorbid conditions among adults 50 years and older with TBI.

Setting: Level I Trauma centers.

Participants: Adults 50 years and older with moderate/severe TBI enrolled in the TBI-Model Systems (TBI-MS) from 2007 to 2014 (n = 2134).

Design: A TBI-MS prospective cohort study.

Main Measures: International Classification of Disease-9th Revision codes collapsed into 45 comorbidity categories. Comorbidity prevalence estimates and trend analyses were conducted by age strata (50-54, 55-64, 65-74, 75-84, ≥85 years). A dimension reduction method, Treelet Transform, classified clusters of comorbidities that tended to co-occur.

Results: The 3 most commonly occurring comorbid categories were hypertensive disease (52.6/100 persons), other diseases of the respiratory system (51.8/100 persons), and fluid component imbalances (43.7/100 persons). Treelet Transform classified 3 clusters of comorbid codes, broadly classified as (1) acute medical diseases/infections, (2) chronic conditions, and (3) substance abuse disorders.

Conclusion: This study provides valuable insight into comorbid conditions that co-occur among adults 50 years and older with TBI and provides a foundation for future studies to explore how specific comorbidities affect TBI recovery.
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http://dx.doi.org/10.1097/HTR.0000000000000273DOI Listing
August 2019