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Shin SM, Cai Y, Itson-Zoske B, Qiu C, Hao X, Xiang H, Hogan QH, Yu H. Enhanced T-type calcium channel 3.2 activity in sensory neurons contributes to neuropathic-like pain of monosodium iodoacetate-induced knee osteoarthritis. Mol Pain 2021; 16:1744806920963807. [PMID: 33054557 PMCID: PMC7570798 DOI: 10.1177/1744806920963807] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
The monosodium iodoacetate knee osteoarthritis model has been widely used for the evaluation of osteoarthritis pain, but the pathogenesis of associated chronic pain is not fully understood. The T-type calcium channel 3.2 (CaV3.2) is abundantly expressed in the primary sensory neurons, in which it regulates neuronal excitability at both the somata and peripheral terminals and facilitates spontaneous neurotransmitter release at the spinal terminals. In this study, we investigated the involvement of primary sensory neuron-CaV3.2 activation in monosodium iodoacetate osteoarthritis pain. Knee joint osteoarthritis pain was induced by intra-articular injection of monosodium iodoacetate (2 mg) in rats, and sensory behavior was evaluated for 35 days. At that time, knee joint structural histology, primary sensory neuron injury, and inflammatory gliosis in lumbar dorsal root ganglia, and spinal dorsal horn were examined. Primary sensory neuron-T-type calcium channel current by patch-clamp recording and CaV3.2 expression by immunohistochemistry and immunoblots were determined. In a subset of animals, pain relief by CaV3.2 inhibition after delivery of CaV3.2 inhibitor TTA-P2 into sciatic nerve was investigated. Knee injection of monosodium iodoacetate resulted in osteoarthritis histopathology, weight-bearing asymmetry, sensory hypersensitivity of the ipsilateral hindpaw, and inflammatory gliosis in the ipsilateral dorsal root ganglia, sciatic nerve, and spinal dorsal horn. Neuronal injury marker ATF-3 was extensively upregulated in primary sensory neurons, suggesting that neuronal damage was beyond merely knee-innervating primary sensory neurons. T-type current in dissociated primary sensory neurons from lumbar dorsal root ganglia of monosodium iodoacetate rats was significantly increased, and CaV3.2 protein levels in the dorsal root ganglia and spinal dorsal horn ipsilateral to monosodium iodoacetate by immunoblots were significantly increased, compared to controls. Perineural application of TTA-P2 into the ipsilateral sciatic nerve alleviated mechanical hypersensitivity and weight-bearing asymmetry in monosodium iodoacetate osteoarthritis rats. Overall, our findings demonstrate an elevated CaV3.2 expression and enhanced function of primary sensory neuron-T channels in the monosodium iodoacetate osteoarthritis pain. Further study is needed to delineate the importance of dysfunctional primary sensory neuron-CaV3.2 in osteoarthritis pain.
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Affiliation(s)
- Seung Min Shin
- Department of Anesthesiology, Medical College of Wisconsin, Milwaukee, WI, USA.,Zablocki Veterans Affairs Medical Center, Milwaukee, WI, USA
| | - Yongsong Cai
- Department of Anesthesiology, Medical College of Wisconsin, Milwaukee, WI, USA.,Xi'an Honghui Hospital, Xi'an, Shaanxi, PR China
| | - Brandon Itson-Zoske
- Department of Anesthesiology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Chensheng Qiu
- Department of Anesthesiology, Medical College of Wisconsin, Milwaukee, WI, USA.,Department of Orthopedic Surgery, Affiliated Hospital of Qingdao University, Qingdao, PR China
| | - Xu Hao
- Department of Anesthesiology, Medical College of Wisconsin, Milwaukee, WI, USA.,Department of Orthopedic Surgery, Affiliated Hospital of Qingdao University, Qingdao, PR China
| | - Hongfei Xiang
- Department of Anesthesiology, Medical College of Wisconsin, Milwaukee, WI, USA.,Department of Orthopedic Surgery, Affiliated Hospital of Qingdao University, Qingdao, PR China
| | - Quinn H Hogan
- Department of Anesthesiology, Medical College of Wisconsin, Milwaukee, WI, USA.,Zablocki Veterans Affairs Medical Center, Milwaukee, WI, USA
| | - Hongwei Yu
- Department of Anesthesiology, Medical College of Wisconsin, Milwaukee, WI, USA.,Zablocki Veterans Affairs Medical Center, Milwaukee, WI, USA
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Bailly F, Cantagrel A, Bertin P, Perrot S, Thomas T, Lansaman T, Grange L, Wendling D, Dovico C, Trouvin AP. Part of pain labelled neuropathic in rheumatic disease might be rather nociplastic. RMD Open 2021; 6:rmdopen-2020-001326. [PMID: 32892169 PMCID: PMC7508212 DOI: 10.1136/rmdopen-2020-001326] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 07/23/2020] [Accepted: 08/21/2020] [Indexed: 01/08/2023] Open
Abstract
Pain in rheumatic diseases is primarily due to mechanical or inflammatory mechanism, but neuropathic pain (NP) component is also occurring in many conditions and is probably underdiagnosed. The purpose of this article is to provide an overview of prevalence, pathophysiological and currently available treatment of NP in rheumatic diseases. When associated with clinical evaluation assessing neurological clinical signs and neuroanatomical distribution, Douleur Neuropathique 4 Questions, painDETECT, Leeds assessment of neuropathic symptoms and signs and Neuropathic Pain Questionnaire can detect NP component. Inflammatory or connective diseases, osteoarthritis, back pain or persistent pain after surgery are aetiologies that all may have a neuropathic component. Unlike nociceptive pain, NP does not respond to usual analgesics such as paracetamol and non-steroidal anti-inflammatory drugs. Entrapment neuropathy, peripheral neuropathy or small-fibre neuropathy are different aetiologies that can lead to NP. A part of the pain labelled neuropathic is rather nociplastic, secondary to a central sensitisation mechanism. Identifying the right component of pain (nociceptive vs neuropathic or nociplastic) could help to better manage pain in rheumatic diseases with pharmacological and non-pharmacological treatments.
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Affiliation(s)
- Florian Bailly
- Pain Department, Pitie-Salpetriere Hospital, Assistance Publique - Hopitaux De Paris, Paris, France .,Paris 6 University, GRC-UPMC 08, Pierre Louis Institute of Epidemiology and Public Health, Paris, France
| | | | | | - Serge Perrot
- Centre d'Evaluation Et Traitement De La Douleur, Université Paris Descartes, Hopital Cochin, Paris, France.,U987, INSERM, Boulogne Billancourt, France
| | | | - Thibaud Lansaman
- Médecine Physique Et Réadaptation, Hôpital Raymond-Poincaré - Assistance Publique Hôpitaux De Paris, Garches, France
| | | | | | - Calogera Dovico
- Service De Médecine Physique Et Réadaptation, Dispositif IEM APF FRANCE HANDICAP, Belfort, France
| | - Anne-Priscille Trouvin
- U987, INSERM, Boulogne Billancourt, France.,Pain Evaluation and Treatment, Hopital Cochin, Paris, France
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Abstract
In rheumatology, chronic pain most often sets in after a musculoskeletal injury. Its persistence is not always due to the progression of the initial injury, but in some cases to the onset of central sensitization. Much scientific data suggests that this central sensitization is caused by multiple complex interactions between the nervous system and immune system. Afferent nerve fibers carrying pain information are responsible for peripheral sensitization partly linked to inflammation molecules. These afferent fibers release neurotransmitters in the dorsal root ganglion and dorsal horn of the spinal cord, capable of activating microglia, which are the local immune cells. The activated microglia will produce pro-inflammatory cytokines, chemokines and neuropeptides capable of interacting with the second-order neuron, but also segmental and descending inhibitory neurons. This is referred to as neuroinflammation, which will amplify the hypersensitivity of second-order neurons, otherwise called central sensitization. This neuroinflammation will be able to reach the higher brain structures, which are involved in pain modulation and the emotional and cognitive aspects of pain. The aim of this update is to describe the pathophysiology of chronic pain, incorporating the latest scientific data on neuroplasticity and neuroinflammation.
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Affiliation(s)
- Pascale Vergne-Salle
- Service de rhumatologie, CHU de Dupuytren 2, 16, rue Bernard-Descottes, 87042 Limoges, France.
| | - Philippe Bertin
- Service de rhumatologie, CHU de Dupuytren 2, 16, rue Bernard-Descottes, 87042 Limoges, France
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Brain gray matter abnormalities in osteoarthritis pain: a cross-sectional evaluation. Pain 2021; 161:2167-2178. [PMID: 32379222 DOI: 10.1097/j.pain.0000000000001904] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 04/01/2020] [Indexed: 02/07/2023]
Abstract
ABSTRACT The interaction between osteoarthritis (OA) pain and brain properties remains minimally understood, although anatomical and functional neuroimaging studies suggest that OA, similar to other chronic pain conditions, may impact as well as partly be determined by brain properties. Here, we studied brain gray matter (GM) properties in OA patients scheduled to undergo total joint replacement surgery. We tested the hypothesis that brain regional GM volume is distinct between hip OA (HOA) and knee OA (KOA) patients, relative to healthy controls and moreover, that these properties are related to OA pain. Voxel-based morphometry group contrasts showed lower anterior cingulate GM volume only in HOA. When we reoriented the brains (flipped) to examine the hemisphere contralateral to OA pain, precentral GM volume was lower in KOA and HOA, and 5 additional brain regions showed distortions between groups. These GM changes, however, did not reflect clinical parameters. Next, we subdivided the brain into larger regions, approximating Brodmann areas, and performed univariable and machine learning-based multivariable contrasts. The univariable analyses approximated voxel-based morphometry results. Our multivariable model distinguished between KOA and controls, was validated in a KOA hold-out sample, and generalized to HOA. The multivariable model in KOA, but not HOA, was related to neuropathic OA pain. These results were mapped into term space (using Neurosynth), providing a meta-analytic summary of brain anatomical distortions in OA. Our results indicate more subtle cortical anatomical differences in OA than previously reported and also emphasize the interaction between OA pain, namely its neuropathic component, and OA brain anatomy.
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Smith TO, Choudhury A, Fletcher J, Choudhury Z, Mansfield M, Tennent D, Hing CB. Changes in pain catastrophization and neuropathic pain following operative stabilisation for patellofemoral instability: a prospective study with twelve month follow-up. INTERNATIONAL ORTHOPAEDICS 2021; 45:1745-1750. [PMID: 33877405 DOI: 10.1007/s00264-021-05046-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 04/12/2021] [Indexed: 01/26/2023]
Abstract
PURPOSE To determine the prevalence and change in neuropathic pain or pain catastrophizing before and 12 months following patellar stabilisation surgery for patellofemoral instability. METHODS We conducted a prospective clinical audit within a UK NHS orthopaedic surgical centre. Data from 84 patients with patellofemoral instability requiring stabilisation were analysed. Fifty percent (42/84) underwent MPFL reconstruction alone, and 16% (13/84) had both trochleoplasty and MPFL reconstruction. Neuropathic pain was assessed using painDETECT score. Pain catastrophizing was assessed using the Pain Catastrophizing Score. The Norwich Patellar Instability (NPI) Score and Kujala Patellofemoral Disorder Score were also routinely collected pre-operatively and one year post-operatively. RESULTS At 12 months post-operatively there was a statistically significant reduction in mean Pain Catastrophizing Scores (18.9-15.7; p < 0.02), but no change in mean painDETECT scores (7.3-7.8; p = 0.72). There was a statistically significant improvement in NPI scores (90.2-61.9; p < 0.01) and Kujala Patellofemoral Disorder Scores (48.7-58.1; p = 0.01). The prevalence of pain catastrophizing decreased from 31% pre-operatively to 24% post-operatively, whereas the prevalence of neuropathic pain remained consisted (10-11%). CONCLUSIONS Neuropathic pain and catastrophizing symptoms are not commonly reported and did not significantly change following patellofemoral stabilisation surgery. Whilst low, for those affected, there remains a need to intervene to improve outcomes following PFI surgery.
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Affiliation(s)
- T O Smith
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK. .,Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK.
| | - A Choudhury
- St George's University Hospitals NHS Foundation Trust, London, UK.,St George's University London, London, UK
| | - J Fletcher
- St George's University London, London, UK
| | - Z Choudhury
- London Business School, Research Laboratory, London, UK
| | - M Mansfield
- Pain Research Cluster; Ageing, Acute and Long Term Conditions Research Group, Institute of Health and Social Care, London South Bank University, London, UK
| | - D Tennent
- St George's University Hospitals NHS Foundation Trust, London, UK
| | - C B Hing
- St George's University Hospitals NHS Foundation Trust, London, UK
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Subchondral bone microenvironment in osteoarthritis and pain. Bone Res 2021; 9:20. [PMID: 33731688 PMCID: PMC7969608 DOI: 10.1038/s41413-021-00147-z] [Citation(s) in RCA: 171] [Impact Index Per Article: 57.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 01/20/2021] [Accepted: 02/01/2021] [Indexed: 01/31/2023] Open
Abstract
Osteoarthritis comprises several joint disorders characterized by articular cartilage degeneration and persistent pain, causing disability and economic burden. The incidence of osteoarthritis is rapidly increasing worldwide due to aging and obesity trends. Basic and clinical research on osteoarthritis has been carried out for decades, but many questions remain unanswered. The exact role of subchondral bone during the initiation and progression osteoarthritis remains unclear. Accumulating evidence shows that subchondral bone lesions, including bone marrow edema and angiogenesis, develop earlier than cartilage degeneration. Clinical interventions targeting subchondral bone have shown therapeutic potential, while others targeting cartilage have yielded disappointing results. Abnormal subchondral bone remodeling, angiogenesis and sensory nerve innervation contribute directly or indirectly to cartilage destruction and pain. This review is about bone-cartilage crosstalk, the subchondral microenvironment and the critical role of both in osteoarthritis progression. It also provides an update on the pathogenesis of and interventions for osteoarthritis and future research targeting subchondral bone.
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58
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Sachau J, Kersebaum D, Baron R, Dickenson AH. Unusual Pain Disorders - What Can Be Learned from Them? J Pain Res 2021; 13:3539-3554. [PMID: 33758536 PMCID: PMC7980038 DOI: 10.2147/jpr.s287603] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 02/18/2021] [Indexed: 12/13/2022] Open
Abstract
Pain is common in many different disorders and leads to a significant reduction in quality of life in the affected patients. Current treatment options are limited and often result in insufficient pain relief, partly due to the incomplete understanding of the underlying pathophysiological mechanisms. The identification of these pathomechanisms is therefore a central object of current research. There are also a number of rare pain diseases, that are generally little known and often undiagnosed, but whose correct diagnosis and examination can help to improve the management of pain disorders in general. In some of these unusual pain disorders like sodium-channelopathies or sensory modulation disorder the underlying pathophysiological mechanisms have only recently been unravelled. These mechanisms might serve as pharmacological targets that may also play a role in subgroups of other, more common pain diseases. In other unusual pain disorders, the identification of pathomechanisms has already led to the development of new drugs. A completely new therapeutic approach, the gene silencing, can even stop progression in hereditary transthyretin amyloidosis and porphyria, ie in pain diseases that would otherwise be rapidly fatal if left untreated. Thus, pain therapists and researchers should be aware of these rare and unusual pain disorders as they offer the unique opportunity to study mechanisms, identify new druggable targets and finally because early diagnosis might save many patient lives.
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Affiliation(s)
- Juliane Sachau
- Division of Neurological Pain Research and Therapy, Department of Neurology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, 24105, Germany
| | - Dilara Kersebaum
- Division of Neurological Pain Research and Therapy, Department of Neurology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, 24105, Germany
| | - Ralf Baron
- Division of Neurological Pain Research and Therapy, Department of Neurology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, 24105, Germany
| | - Anthony H Dickenson
- Department of Neuroscience, Physiology and Pharmacology, University College London, London, WC1E 6BT, UK
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59
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Liu J, Ting JP, Al-Azzam S, Ding Y, Afshar S. Therapeutic Advances in Diabetes, Autoimmune, and Neurological Diseases. Int J Mol Sci 2021; 22:ijms22062805. [PMID: 33802091 PMCID: PMC8001105 DOI: 10.3390/ijms22062805] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 03/02/2021] [Accepted: 03/06/2021] [Indexed: 02/08/2023] Open
Abstract
Since 2015, 170 small molecules, 60 antibody-based entities, 12 peptides, and 15 gene- or cell-therapies have been approved by FDA for diverse disease indications. Recent advancement in medicine is facilitated by identification of new targets and mechanisms of actions, advancement in discovery and development platforms, and the emergence of novel technologies. Early disease detection, precision intervention, and personalized treatments have revolutionized patient care in the last decade. In this review, we provide a comprehensive overview of current and emerging therapeutic modalities developed in the recent years. We focus on nine diseases in three major therapeutics areas, diabetes, autoimmune, and neurological disorders. The pathogenesis of each disease at physiological and molecular levels is discussed and recently approved drugs as well as drugs in the clinic are presented.
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Affiliation(s)
- Jinsha Liu
- Protein Engineering, Lilly Biotechnology Center, Eli Lilly and Company, San Diego, CA 92121, USA; (J.L.); (J.P.T.); (Y.D.)
| | - Joey Paolo Ting
- Protein Engineering, Lilly Biotechnology Center, Eli Lilly and Company, San Diego, CA 92121, USA; (J.L.); (J.P.T.); (Y.D.)
| | - Shams Al-Azzam
- Professional Scientific Services, Eurofins Lancaster Laboratories, Lancaster, PA 17605, USA;
| | - Yun Ding
- Protein Engineering, Lilly Biotechnology Center, Eli Lilly and Company, San Diego, CA 92121, USA; (J.L.); (J.P.T.); (Y.D.)
| | - Sepideh Afshar
- Protein Engineering, Lilly Biotechnology Center, Eli Lilly and Company, San Diego, CA 92121, USA; (J.L.); (J.P.T.); (Y.D.)
- Correspondence:
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Zhou L, Gu M, Ma X, Wen L, Zhang B, Lin Y, Pan J. Long non-coding RNA PCAT-1 regulates apoptosis of chondrocytes in osteoarthritis by sponging miR-27b-3p. J Bone Miner Metab 2021; 39:139-147. [PMID: 32770398 DOI: 10.1007/s00774-020-01128-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 07/05/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Osteoarthritis (OA) is a non-inflammatory degenerative disease, with progressive damages on the articular cartilages. In recent years, researchers have paid many efforts in the diagnostics and treatments of OA. However, no effective therapeutic method has been revealed to help inhibit the development of OA. Herein, we studied the roles and associations of PCAT-1 and miR-27-3p in the pathogenesis OA. METHODS OA articular cartilages and healthy articular cartilages were isolated for investigation. The chondrocytes were isolated from articular cartilage samples. QRT-PCR and western blotting were used for the detection of expression of genes and proteins. cell Titer 96® AQueous one proliferation kit was applied for detect cell viability of Chondrocytes transfected with negative control vector, pcDNA3.1 PCAT-1 plasmid or siRNA against PCAT-1. RNA pull-down assays and Luciferase reporter assay were used to confirm the connection. SPSS 17.0 was employed for statistical analysis. RESULTS We found that the expressions of PCAT-1 were up-regulated in OA chondrocytes compared with normal chondrocytes. si-PCAT-1 suppressed apoptotic OA chondrocytes. Over-expression of PCAT-1 enhanced the apoptosis of normal chondrocytes. In addition, the online database and luciferase assay confirmed that PCAT-1 could directly target miR-27b-3p. PCAT-1 could promote the apoptosis of OA and normal chondrocytes through binding with miR-27b-3p. CONCLUSIONS Based on the comparisons and analysis, we could conclude that lncRNA PCAT-1 regulated the apoptosis of chondrocytes through sponging miR-27b-3p in OA. PCAT-1 has potential values to act as a new therapeutic target for OA patients.
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Affiliation(s)
- Lei Zhou
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, 8th Gongren Tiyuchang Nanlu, Chaoyang, Beijing, 100020, China
- Joint Laboratory for Translational Medicine Research, Beijing Institute of Genomics, Chinese Academy of Sciences & Liaocheng People's Hospital, Liaocheng, 252000, China
| | - Mingliang Gu
- CAS Key Laboratory of Genome Sciences and Information, Beijing Institute of Genomics, Chinese Academy of Sciences, Beijing, 100101, China
| | - Xiao Ma
- State Key Laboratory of Molecular Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Liang Wen
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, 8th Gongren Tiyuchang Nanlu, Chaoyang, Beijing, 100020, China
| | - Bo Zhang
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, 8th Gongren Tiyuchang Nanlu, Chaoyang, Beijing, 100020, China
| | - Yuan Lin
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, 8th Gongren Tiyuchang Nanlu, Chaoyang, Beijing, 100020, China
| | - Jiang Pan
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, 8th Gongren Tiyuchang Nanlu, Chaoyang, Beijing, 100020, China.
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Mouraux A, Bannister K, Becker S, Finn DP, Pickering G, Pogatzki-Zahn E, Graven-Nielsen T. Challenges and opportunities in translational pain research - An opinion paper of the working group on translational pain research of the European pain federation (EFIC). Eur J Pain 2021; 25:731-756. [PMID: 33625769 PMCID: PMC9290702 DOI: 10.1002/ejp.1730] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
For decades, basic research on the underlying mechanisms of nociception has held promise to translate into efficacious treatments for patients with pain. Despite great improvement in the understanding of pain physiology and pathophysiology, translation to novel, effective treatments for acute and chronic pain has however been limited, and they remain an unmet medical need. In this opinion paper bringing together pain researchers from very different disciplines, the opportunities and challenges of translational pain research are discussed. The many factors that may prevent the successful translation of bench observations into useful and effective clinical applications are reviewed, including interspecies differences, limited validity of currently available preclinical disease models of pain, and limitations of currently used methods to assess nociception and pain in non-human and human models of pain. Many paths are explored to address these issues, including the backward translation of observations made in patients and human volunteers into new disease models that are more clinically relevant, improved generalization by taking into account age and sex differences, and the integration of psychobiology into translational pain research. Finally, it is argued that preclinical and clinical stages of developing new treatments for pain can be improved by better preclinical models of pathological pain conditions alongside revised methods to assess treatment-induced effects on nociception in human and non-human animals. Significance: For decades, basic research of the underlying mechanisms of nociception has held promise to translate into efficacious treatments for patients with pain. Despite great improvement in the understanding of pain physiology and pathophysiology, translation to novel, effective treatments for acute and chronic pain has however been limited, and they remain an unmet medical need.
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Affiliation(s)
- André Mouraux
- Institute of Neuroscience (IONS), UCLouvain, Brussels, Belgium
| | - Kirsty Bannister
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Susanne Becker
- Department of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.,Integrative Spinal Research, Department of Chiropractic Medicine, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - David P Finn
- Pharmacology and Therapeutics, Centre for Pain Research, School of Medicine, National University of Ireland Galway, Galway, Ireland
| | - Gisèle Pickering
- Department of Clinical Pharmacology, Inserm CIC 1405, University Hospital, CHU Clermont-Ferrand, France.,Fundamental and Clinical Pharmacology of Pain, University Clermont Auvergne, Clermont-Ferrand, France
| | - Esther Pogatzki-Zahn
- Department of Anesthesiology, Critical Care Medicine and Pain Therapy, University Hospital Muenster, Muenster, Germany
| | - Thomas Graven-Nielsen
- Center for Neuroplasticity and Pain (CNAP), Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
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Li Y, Yang Y, Guo J, Guo X, Feng Z, Zhao X. Spinal NF-kB upregulation contributes to hyperalgesia in a rat model of advanced osteoarthritis. Mol Pain 2021; 16:1744806920905691. [PMID: 31971058 PMCID: PMC7040927 DOI: 10.1177/1744806920905691] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Knee osteoarthritis (OA) pain is the most common joint pain. Currently, dysfunction in the central nervous system rather than knee joint degeneration is considered to be the major cause of chronic knee OA pain; however, the underlying mechanism remains unknown. The aim of this study was to explore whether spinal NF-κB plays a critical role in chronic knee OA pain. In this study, we used a model induced by the intra-articular injection of monosodium iodoacetate. Spinal NF-κB and the phosphorylation and activation status of NF-κB p65/RelA (p-p65) were inhibited by the intrathecal injection of the inhibitor pyrrolidine dithiocarbamate in this model. After behavioral assessment, the knee was dissected for histopathology, and the spinal cord was dissected and examined for NF-κB, p-p65, and cytokine expression. Furthermore, the quantity and activity of neurons, astrocytes, and microglial cells and their colocalization with p-p65 in the spinal dorsal horn were investigated. Our findings included the following: (1) histology, the pathological changes in the joints of the knee OA model were basically consistent with knee OA patients; (2) the protein and transcription levels of NF-κB/p65 and p-p65 increased before day 14, appeared to decrease on day 21 and increased again on day 28, and the tendency of weight bearing was similar; (3) on days 21 and 28, the intrathecal injection of pyrrolidine dithiocarbamate markedly prevented the monosodium iodoacetate-induced reduction in the paw withdrawal threshold; (4) real-time polymerase chain reaction demonstrated that the expression of TNF-α and IL-33 was suppressed in the knee OA model by the intrathecal injection of pyrrolidine dithiocarbamate; and (5) immunofluorescence revealed that astrocytes were activated and that p-p65 was mainly increased in astrocytes. Our findings indicate that the spinal NF-κB/p65 pathway in astrocytes modulates neuroimmunity in rat model of intra-articular monosodium iodoacetate-induced advanced OA.
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Affiliation(s)
- Yunze Li
- Department of Pain Medicine, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China.,Department of Pain Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yixin Yang
- Department of Pain Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jinwan Guo
- Department of Anesthesiology, Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Xuejiao Guo
- Department of Pain Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Zhiying Feng
- Department of Pain Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xuli Zhao
- Department of Pain Medicine, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
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Zhou L, Bhattacharjee S, Kwoh CK, Malone DC, Tighe PJ, Reisfield GM, Slack M, Wilson DL, Lo-Ciganic WH. Association Between Dual Trajectories of Opioid and Gabapentinoid Use and Healthcare Expenditures Among US Medicare Beneficiaries. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2021; 24:196-205. [PMID: 33518026 PMCID: PMC8359825 DOI: 10.1016/j.jval.2020.12.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 11/30/2020] [Accepted: 12/08/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVES Little is known about relationships between opioid- and gabapentinoid-use patterns and healthcare expenditures that may be affected by pain management and risk of adverse outcomes. This study examined the association between patients' opioid and gabapentinoid prescription filling/refilling trajectories and direct medical expenditures in US Medicare. METHODS This cross-sectional study included a 5% national sample (2011-2016) of fee-for-service beneficiaries with fibromyalgia, low back pain, neuropathy, or osteoarthritis newly initiating opioids or gabapentinoids. Using group-based multitrajectory modeling, this study identified patients' distinct opioid and gabapentinoid (OPI-GABA) dose and duration patterns, based on standardized daily doses, within a year of initiating opioids and/or gabapentinoids. Concurrent direct medical expenditures within the same year were estimated using inverse probability of treatment weighted multivariable generalized linear regression, adjusting for sociodemographic and health status factors. RESULTS Among 67 827 eligible beneficiaries (mean age ± SD = 63.6 ± 14.8 years, female = 65.8%, white = 77.1%), 11 distinct trajectories were identified (3 opioid-only, 4 gabapentinoid-only, and 4 concurrent OPI-GABA trajectories). Compared with opioid-only early discontinuers ($13 830, 95% confidence interval = $13 643-14 019), gabapentinoid-only early discontinuers and consistent low-dose and moderate-dose gabapentinoid-only users were associated with 11% to 23% lower health expenditures (adjusted mean expenditure = $10 607-$11 713). Consistent low-dose opioid-only users, consistent high-dose opioid-only users, consistent low-dose OPI-GABA users, consistent low-dose opioid and high-dose gabapentinoid users, and consistent high-dose opioid and moderate-dose gabapentinoid users were associated with 14% to 106% higher healthcare expenditures (adjusted mean expenditure = $15 721-$28 464). CONCLUSIONS Dose and duration patterns of concurrent OPI-GABA varied substantially among fee-for-service Medicare beneficiaries. Consistent opioid-only users and all concurrent OPI-GABA users were associated with higher healthcare expenditures compared to opioid-only discontinuers.
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Affiliation(s)
- Lili Zhou
- Department of Pharmacy Practice and Science, University of Arizona, Tucson, AZ, USA; University of Arizona Arthritis Center, Tucson, AZ, USA
| | | | - C Kent Kwoh
- University of Arizona Arthritis Center, Tucson, AZ, USA; Department of Medicine, University of Arizona, Tucson, AZ, USA
| | - Daniel C Malone
- Department of Pharmacotherapy, University of Utah, Salt Lake City, UT, USA
| | - Patrick J Tighe
- Department of Anesthesiology, University of Florida, Gainesville, FL, USA
| | - Gary M Reisfield
- Divisions of Addiction Medicine & Forensic Psychiatry, Departments of Psychiatry & Anesthesiology, University of Florida, Gainesville, FL, USA
| | - Marion Slack
- Department of Pharmacy Practice and Science, University of Arizona, Tucson, AZ, USA
| | - Debbie L Wilson
- Department of Pharmaceutical Outcomes and Policy, University of Florida, Gainesville, FL, USA
| | - Wei-Hsuan Lo-Ciganic
- Department of Pharmaceutical Outcomes and Policy, University of Florida, Gainesville, FL, USA; Center for Drug Evaluation and Safety, University of Florida, Gainesville, FL, USA.
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Terry EL, Booker SQ, Cardoso JS, Sibille KT, Bartley EJ, Glover TL, Vaughn IA, Thompson KA, Bulls HW, Addison AS, Staud R, Hughes LB, Edberg JC, Redden DT, Bradley LA, Goodin BR, Fillingim RB. Neuropathic-Like Pain Symptoms in a Community-Dwelling Sample with or at Risk for Knee Osteoarthritis. PAIN MEDICINE 2021; 21:125-137. [PMID: 31150093 DOI: 10.1093/pm/pnz112] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To characterize neuropathic-like pain among individuals with or at risk for knee osteoarthritis. SUBJECTS One hundred eighty-four individuals who self-identified as non-Hispanic black or non-Hispanic white and presented with unilateral or bilateral knee pain. DESIGN Neuropathic-like pain was assessed using the painDETECT, and those with high vs low neuropathic-like pain were compared on clinical pain, psychological symptoms, physical function, and quantitative sensory testing. Analyses were unadjusted, partially and fully adjusted for relevant covariates. RESULTS Thirty-two (17.4%) participants reported experiencing neuropathic-like pain features above the painDETECT clinical cut-score. The neuropathic-like pain group reported significantly greater pain severity on all measures of clinical pain and higher levels of psychological symptoms when fully adjusted for covariates, but no differences emerged for disability and lower extremity function. The neuropathic-like pain group also reported greater overall heat pain ratings during the heat pain threshold and increased temporal summation of heat pain in the fully adjusted model. Additionally, those with neuropathic-like pain symptoms reported greater painful after-sensations following heat pain temporal summation in all analyses. No significant group differences in pressure pain threshold emerged at any of the testing sites. In contrast, temporal summation of mechanical pain was significantly greater at both the index knee and the ipsilateral hand for the neuropathic-like pain group in all analyses. CONCLUSIONS Participants with or at risk for knee osteoarthritis who reported high neuropathic-like pain experienced significantly greater clinical pain and increased heat and mechanical temporal summation at the index knee and other body sites tested, suggesting central sensitization.
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Affiliation(s)
- Ellen L Terry
- Pain Research and Intervention Center of Excellence (PRICE), University of Florida, Gainesville, Florida
| | - Staja Q Booker
- Pain Research and Intervention Center of Excellence (PRICE), University of Florida, Gainesville, Florida
| | - Josue S Cardoso
- Pain Research and Intervention Center of Excellence (PRICE), University of Florida, Gainesville, Florida
| | - Kimberly T Sibille
- Pain Research and Intervention Center of Excellence (PRICE), University of Florida, Gainesville, Florida
| | - Emily J Bartley
- Pain Research and Intervention Center of Excellence (PRICE), University of Florida, Gainesville, Florida
| | - Toni L Glover
- College of Nursing, University of Florida, Gainesville, Florida
| | - Ivana A Vaughn
- Pain Research and Intervention Center of Excellence (PRICE), University of Florida, Gainesville, Florida
| | - Kathryn A Thompson
- Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Hailey W Bulls
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL
| | - Adriana S Addison
- Division of Clinical Immunology & Rheumatology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Roland Staud
- Pain Research and Intervention Center of Excellence (PRICE), University of Florida, Gainesville, Florida
| | - Laura B Hughes
- Division of Clinical Immunology & Rheumatology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Jeffrey C Edberg
- Division of Clinical Immunology & Rheumatology, University of Alabama at Birmingham, Birmingham, Alabama
| | - David T Redden
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Laurence A Bradley
- Division of Clinical Immunology & Rheumatology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Burel R Goodin
- Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Roger B Fillingim
- Pain Research and Intervention Center of Excellence (PRICE), University of Florida, Gainesville, Florida
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Fayet M, Hagen M. Pain characteristics and biomarkers in treatment approaches for osteoarthritis pain. Pain Manag 2021; 11:59-73. [DOI: 10.2217/pmt-2020-0055] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Osteoarthritis (OA) is a progressive disease and OA pain intensity is related to ongoing pathophysiological changes. However, OA pain is complex and multimodal; its characteristics, including severity, localization and the stimuli that elicit it, can change as the disease progresses and differ greatly among patients. Understanding mechanisms underlying specific pain characteristics may help guide clinicians in choosing appropriate treatments, targeting treatments to those patients most likely to benefit. Associations have been demonstrated between biomarkers and some characteristics of OA pain, and to processes linked to the shift in pain characteristics over the course of OA. This article examines how understanding OA pain characteristics and their relation to the disease process could inform treatment choice when applying well-established treatment guidelines.
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Affiliation(s)
- Marina Fayet
- GSK Consumer Healthcare S.A., Route de l'Etraz 2, 1260, Nyon, Switzerland
| | - Martina Hagen
- GSK Consumer Healthcare S.A., Route de l'Etraz 2, 1260, Nyon, Switzerland
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66
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Lassen J, Baron R. [Rheumatic diseases and neuropathic pain : Diagnosis and treatment]. Z Rheumatol 2020; 80:226-233. [PMID: 33355701 DOI: 10.1007/s00393-020-00950-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2020] [Indexed: 11/29/2022]
Abstract
Pain is a leading symptom in inflammatory rheumatic diseases. For a long time it has been assumed that this pain is of nociceptive origin; however, in about one fifth of all patients the pain remains despite successful anti-inflammatory treatment and is not typically described as nociceptive by those affected. Recent studies indicate that some patients with rheumatoid arthritis (RA) experience pain with a neuropathic pain component. The treatment of neuropathic pain with damage to the somatosensory system differs markedly from the treatment of nociceptive pain in which the pain processing system is intact. Thus, the recognition and, above all, the more precise differentiation of the pain symptoms of affected patients make a decisive contribution to a successful treatment. With the help of a few points in the history and a physical examination, the assumption of the diagnosis neuropathic pain can often be rejected or substantiated. Pain with a neuropathic component does not adequately respond to typical analgesics. Instead, the high efficacy of co-analgesics, such as anticonvulsants and antidepressants, has been repeatedly proven.
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Affiliation(s)
- J Lassen
- Sektion Neurologische Schmerzforschung und -therapie, Klinik für Neurologie, Christian-Albrechts-Universität zu Kiel, Arnold-Heller-Str. 3, Haus D, 24105, Kiel, Deutschland
| | - R Baron
- Sektion Neurologische Schmerzforschung und -therapie, Klinik für Neurologie, Christian-Albrechts-Universität zu Kiel, Arnold-Heller-Str. 3, Haus D, 24105, Kiel, Deutschland.
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An Investigation of the Molecular Mechanisms Underlying the Analgesic Effect of Jakyak-Gamcho Decoction: A Network Pharmacology Study. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2020; 2020:6628641. [PMID: 33343676 PMCID: PMC7732394 DOI: 10.1155/2020/6628641] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 11/05/2020] [Accepted: 11/24/2020] [Indexed: 12/20/2022]
Abstract
Herbal drugs have drawn substantial interest as effective analgesic agents; however, their therapeutic mechanisms remain to be fully understood. To address this question, we performed a network pharmacology study to explore the system-level mechanisms that underlie the analgesic activity of Jakyak-Gamcho decoction (JGd; Shaoyao-Gancao-Tang in Chinese and Shakuyaku-Kanzo-To in Japanese), an herbal prescription consisting of Paeonia lactiflora Pallas and Glycyrrhiza uralensis Fischer. Based on comprehensive information regarding the pharmacological and chemical properties of the herbal constituents of JGd, we identified 57 active chemical compounds and their 70 pain-associated targets. The JGd targets were determined to be involved in the regulation of diverse biological activities as follows: calcium- and cytokine-mediated signalings, calcium ion concentration and homeostasis, cellular behaviors of muscle and neuronal cells, inflammatory response, and response to chemical, cytokine, drug, and oxidative stress. The targets were further enriched in various pain-associated signalings, including the PI3K-Akt, estrogen, ErbB, neurotrophin, neuroactive ligand-receptor interaction, HIF-1, serotonergic synapse, JAK-STAT, and cAMP pathways. Thus, these data provide a systematic basis to understand the molecular mechanisms underlying the analgesic activity of herbal drugs.
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Hahm SC, Lee JS, Yoon YW, Kim J. Analgesic Tolerance Development during Repetitive Electric Stimulations Is Associated with Changes in the Expression of Activated Microglia in Rats with Osteoarthritis. Biomedicines 2020; 8:biomedicines8120575. [PMID: 33297333 PMCID: PMC7762208 DOI: 10.3390/biomedicines8120575] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 12/01/2020] [Accepted: 12/05/2020] [Indexed: 11/30/2022] Open
Abstract
Electric stimulation is used for managing osteoarthritic (OA) pain; however, little is known about the development of analgesic tolerance during repeated stimulations and the relation of spinal microglia with OA pain. We investigated the changes in the analgesic effects of repeated electric stimulations and the relation between the development of analgesic tolerance and spinal microglial expression in rats with OA. To induce OA, monosodium iodoacetate was injected into the synovial space of the right knee joint of the rats (n = 185). Repeated high frequency, low frequency, or sham transcutaneous electric nerve stimulation (TENS) was performed to the ipsilateral knee joint for 20 min in rats with OA (n = 45). Minocycline or minocycline plus TENS (HF, LF, or sham) was treated in OA rats with repeated TENS-induced tolerance (n = 135). Immunohistochemistry of the microglia in the L3–L5 spinal segments was performed. Knee joint pain during passive movement of the knee joint were quantified using the knee-bend score and the proportion of activated microglia was calculated as primary variables. Paw withdrawal threshold (hypersensitivity to mechanical stimuli) was assessed and the resting and activated microglia were counted as secondary variables. Repeated applications decreased the analgesic effect of TENS on OA pain and failed to reduce the expression of activated microglia in the spinal cord. However, spinal microglial inhibition by minocycline restored the analgesic effect of TENS on OA pain in TENS-tolerant OA rats. TENS combined with minocycline treatment improved knee joint pain and mechanical hypersensitivity in TENS-tolerant OA rats, and inhibited the expression of activated microglia in the spinal cord. These results suggest a possible relationship between repetitive electric stimulation-induced analgesic tolerance for OA pain control and changes in microglia activation.
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Affiliation(s)
- Suk-Chan Hahm
- Graduate School of Integrative Medicine, CHA University, Seongnam 13488, Korea;
| | - Jin Seung Lee
- Department of Physical Therapy, Korea University College of Health Science, Seoul 02841, Korea;
- Rehabilitation Science Program, Department of Health Sciences, Graduate School, Korea University, Seoul 02841, Korea
- BK21FOUR R&E Center for Learning Health Systems, Korea University, Seoul 02841, Korea
| | - Young Wook Yoon
- Department of Physiology, Korea University College of Medicine, Seoul 02841, Korea;
| | - Junesun Kim
- Department of Physical Therapy, Korea University College of Health Science, Seoul 02841, Korea;
- Rehabilitation Science Program, Department of Health Sciences, Graduate School, Korea University, Seoul 02841, Korea
- BK21FOUR R&E Center for Learning Health Systems, Korea University, Seoul 02841, Korea
- Correspondence: ; Tel.: +82-2-3290-5689; Fax: +82-2-921-7260
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Examining the role of transient receptor potential canonical 5 (TRPC5) in osteoarthritis. OSTEOARTHRITIS AND CARTILAGE OPEN 2020; 2:100119. [PMID: 33381767 PMCID: PMC7762818 DOI: 10.1016/j.ocarto.2020.100119] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 11/02/2020] [Indexed: 01/09/2023] Open
Abstract
Introduction Osteo-arthritis (OA) involves joint degradation and usually pain; with mechanisms poorly understood and few treatment options. There is evidence that the transient receptor potential canonical 5 (TRPC5) mRNA expression is reduced in OA patients’ synovia. Here we examine the profile of TRPC5 in DRG and involvement in murine models of OA. Design TRPC5 KO mice were subjected to partial meniscectomy (PMNX) or injected with monoiodoacetate (MIA) and pain-related behaviours were determined. Knee joint pathological scores were analysed and gene expression changes in ipsilateral synovium and dorsal root ganglia (DRG) determined. c-Fos protein expression in the ipsilateral dorsal horn of the spinal cord was quantified. Results TRPC5 KO mice developed a discrete enhanced pain-related phenotype. In the MIA model, the pain-related phenotype correlated with c-Fos expression in the dorsal horn and increased expression of nerve injury markers ATF3, CSF1 and galanin in the ipsilateral DRG. There were negligible differences in the joint pathology between WT and TRPC5 KO mice, however detailed gene expression analysis determined increased expression of the mast cell marker CD117 as well as extracellular matrix remodelling proteinases MMP2, MMP13 and ADAMTS4 in MIA-treated TRPC5 KO mice. TRPC5 expression was defined to sensory subpopulations in DRG. Conclusions Deletion of TRPC5 receptor signalling is associated with exacerbation of pain-like behaviour in OA which correlates with increased expression of enzymes involved in extracellular remodelling, inflammatory cells in the synovium and increased neuronal activation and injury in DRG. Together, these results identify a modulating role for TRPC5 in OA-induced pain-like behaviours.
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Finco G, Evangelista M, Sardo S. Basic guide to chronic pain assessment: from neurophysiology to bedside. Minerva Anestesiol 2020; 86:1321-1330. [DOI: 10.23736/s0375-9393.20.14573-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Nigoro K, Ito H, Kawata T, Nishitani K, Tabara Y, Matsuda F, Narumiya S, Matsuda S. Obesity with radiological changes or depression was associated with worse knee outcome in general population: a cluster analysis in the Nagahama study. Arthritis Res Ther 2020; 22:280. [PMID: 33246505 PMCID: PMC7694310 DOI: 10.1186/s13075-020-02375-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 11/19/2020] [Indexed: 02/06/2023] Open
Abstract
Background In knee osteoarthritis (OA), pain is the most frequent and dominant symptom. However, which factors other than radiological changes contribute to the symptoms is unresolved. The aims of this study were to identify factors affecting knee pain from various variables with radiological changes taken into count and exploratively examine what subgroups or phenotype could be identified by cluster analysis using the identified knee pain factors. Methods Patients 60 years or older who underwent radiographic evaluation were included in this cross-sectional study, and those subjects who completed a questionnaire about knee symptoms without missing data were eligible for analysis. Multiple regression analysis was used to examine the associations between selected variables and The Japanese Knee Osteoarthritis Measure (JKOM) pain score. We grouped the subjects by cluster analysis using identified variables. Results Two thousand five hundred forty-two subjects were included in the full set of analyses. Age, body mass index (BMI), radiological grade, bone mineral density (BMD), and high-sensitivity C-reactive protein (hs-CRP) showed a statistically significant correlation with radiological showing the strongest value. For dichotomous variable, presence of depression showed a statistically significant result. We used BMI, radiological grade, BMD, hs-CRP, and presence of depression as a variable for cluster analysis and identified six subgroups: (1) minimal joint disease subgroup, (2) male and high BMD subgroup, (3) high CRP subgroup, (4) severe radiological OA subgroup, (5) depressive subgroup, and (6) moderate radiological OA with high BMI subgroup, showing the worst knee outcome. Conclusion This study identified the factors affecting knee pain other than radiological changes and identified six subgroups of knee outcome in the general population. The results showed that obesity with radiological changes or depression was associated with worse knee outcome.
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Affiliation(s)
- Kazuya Nigoro
- Department of Drug Discovery Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Hiromu Ito
- Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan. .,Department of Advanced Medicine for Rheumatic Diseases, Kyoto University Graduate School of Medicine, Kyoto, Japan.
| | - Tomotoshi Kawata
- Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Kohei Nishitani
- Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yasuharu Tabara
- Center for Genomic Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Fumihiko Matsuda
- Center for Genomic Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Shu Narumiya
- Department of Drug Discovery Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Shuichi Matsuda
- Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
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Cai C, Zhang R, Xu X, Li G, Gou H. Diagnostic values of NLR and miR-141 in patients with osteoarthritis and their association with severity of knee osteoarthritis. Exp Ther Med 2020; 21:74. [PMID: 33365074 PMCID: PMC7716640 DOI: 10.3892/etm.2020.9506] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 07/06/2020] [Indexed: 12/26/2022] Open
Abstract
The present study aimed to explore the diagnostic values of neutrophil-lymphocyte ratio (NLR) and microRNA (miR)-141 in patients with osteoarthritis and their association with the severity of knee osteoarthritis. In total 142 patients with osteoarthritis (the study group) admitted to Shanghai TCM-Integrated Hospital, Shanghai University of TCM from January 2017 to January 2019 and 150 healthy controls (the control group) were enrolled in the present study. NLR and miR-141 in peripheral blood and their diagnostic values for osteoarthritis were compared between the two groups. The two indicators in the study group were significantly increased (P<0.001), and their combined detection had a better diagnostic value for the disease (P<0.001). Moreover, they were closely associated to the progression of the disease and were independent risk factors (P<0.001). To sum up, NLR and miR-141 were significantly increased in the peripheral blood of patients with osteoarthritis. Their combined detection exhibited a good diagnostic value for the disease and may become a potential therapeutic target osteoarthritis in the future.
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Affiliation(s)
- Chengchen Cai
- Department of Traditional Chinese Medicine, Huadong Hospital, Fudan University, Shanghai 200040, P.R. China
| | - Ruojing Zhang
- Department of Scientific Research, Shanghai TCM-Integrated Hospital, Shanghai University of TCM, Shanghai 200082, P.R. China
| | - Xiaoli Xu
- Department of Traditional Chinese Medicine, Huadong Hospital, Fudan University, Shanghai 200040, P.R. China
| | - Guowen Li
- Department of Scientific Research, Shanghai TCM-Integrated Hospital, Shanghai University of TCM, Shanghai 200082, P.R. China
| | - Haixin Gou
- Department of Traditional Chinese Medicine, Huadong Hospital, Fudan University, Shanghai 200040, P.R. China
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Beths T, Munn R, Bauquier SH, Mitchell P, Whittem T. A pilot study of 4CYTE™ Epiitalis® Forte, a novel nutraceutical, in the management of naturally occurring osteoarthritis in dogs. Aust Vet J 2020; 98:591-595. [PMID: 32978786 DOI: 10.1111/avj.13024] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 09/06/2020] [Accepted: 09/11/2020] [Indexed: 01/13/2023]
Abstract
The primary goal of this pilot study was to assess, the efficacy of a new nutraceutical, 4CYTE™ Epiitalis® Forte, containing, as a standalone, a proprietary plant oil extract, Epiitalis, in dogs presenting with signs of osteoarthritis (OA). Fifty dogs aged 9.2 (±3.2) years with signs of naturally occurring OA were included in this report. They were free of other comorbidities and were not on any medications except for those utilised for managing their OA. In these dogs, the current treatments were continued to avoid any sudden changes in their disease management. The effects of the 4CYTE Epiitalis Forte were assessed both at the beginning and at the end of a 1 month-long treatment period. The evaluation consisted of an objective lameness assessment (TPI%[total pressure index]) using a gait analysis (GAITRite® Portable Walkway System) and a subjective quality-of-life questionnaire, the Helsinki Chronic Pain Index (HCPI). Additional exploratory objective measurements included the Symmetry Index (SI) and the fore/hind limb ratio (T/P TPI%). Of dogs, 74% (34/46) registered a numerical improvement in TPI% in their worse limb. In addition, of the 93.5% of the dogs that demonstrated improvement in their HCPI scores by at least 5% on the quality-of-life questionnaire, 79% demonstrated improvements in gait based on TPI%. Finally, there were improvements measured in both exploratory objective endpoints SI and T/P TPI%. These encouraging results will be used to develop a protocol for a follow-up placebo-controlled randomised study to confirm the efficacy of this new nutraceutical for dogs suffering from OA.
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Affiliation(s)
- T Beths
- Melbourne Veterinary School, Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Werribee, Victoria, 3030, Australia
| | - R Munn
- Melbourne Veterinary School, Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Werribee, Victoria, 3030, Australia
| | - S H Bauquier
- Melbourne Veterinary School, Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Werribee, Victoria, 3030, Australia
| | - P Mitchell
- Melbourne Veterinary School, Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Werribee, Victoria, 3030, Australia
| | - T Whittem
- Melbourne Veterinary School, Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Werribee, Victoria, 3030, Australia
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Jin H, Ma X, Liu Y, Liu M, Yin X, Fan W, Zhu J, Zhao JH, Chen L, Su N, Xie Y, Yang J, Liu P. Back pain from painful osteoporotic vertebral fractures: discrepancy between the actual fracture location and the location suggested by patient-reported pain or physical examination findings. Osteoporos Int 2020; 31:1721-1732. [PMID: 32346773 DOI: 10.1007/s00198-020-05434-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 04/22/2020] [Indexed: 01/23/2023]
Abstract
UNLABELLED Caution is necessary when using symptom or physical examination findings to localize the osteoporotic vertebral fractures (VFs) attributable to the discrepant colocalized relationship. INTRODUCTION Whether the location of symptoms or physical examination findings delineates the appropriate spinal range for imaging has not been thoroughly investigated for VFs. The present study aims to analyze the consistency between the fractural vertebrae location and the location suggested by patient-reported pain or physical examination findings. METHODS This observational study, following a prospective design, enrolled 358 patients with VFs. The locations of two symptoms (patient-reported back pain [P-RBP], radiating pain [RP]) and findings from two physical examinations (spinal palpation tenderness [SPT], axial spinal percussion pain [ASPP]) were used to locate the VF segments identified using whole-spine magnetic resonance imaging (MRI). The percentage of agreements and kappa coefficient were calculated. RESULTS In 20.7% (74/358), the P-RBP site and VF segments were in the same location (kappa = 0.153); 21.2% (76/358) presented with concomitant RP in 93.4% (71/76) of whom the RP dermatome was colocalized with the VF segments (kappa = 0.924); 55.0% (197/358) and 23.2% (83/358) of patients presented with positive SPT and ASPP, respectively; and in 49.2% (97/197) and 96.4% (80/83) of patients with positive SPT (kappa = 0.435) and ASPP (kappa = 0.963), the positive finding and the VF segments were consistently colocalized. CONCLUSIONS The positive finding of RP or ASPP is useful in determining the spinal range for imaging tests, while an MRI scan covering the whole thoracic and lumbar spine is necessary in VF-suspected patients with P-RBP or positive SPT, indicating that caution is necessary when using symptoms or physical examination findings to localize VFs.
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Affiliation(s)
- H Jin
- Department of Spine Surgery, Center of Orthopedics, Daping Hospital (Army Medical Center of PLA), Army Medical University, No. 10 Changjiang Branch Road, Yuzhong District, Chongqing, China
- Department of Orthopedics and Neurosurgery, Army 954th Hospital, Shannan, Tibet, China
| | - X Ma
- Department of Wound Infection and Drug, State Key Laboratory of Trauma, Burns and Combined Injury, Research Institute of Surgery, Daping Hospital (Army Medical Center of PLA), Army Medical University, Chongqing, China
| | - Y Liu
- Department of Spine Surgery, Center of Orthopedics, Daping Hospital (Army Medical Center of PLA), Army Medical University, No. 10 Changjiang Branch Road, Yuzhong District, Chongqing, China
| | - M Liu
- Department of Spine Surgery, Center of Orthopedics, Daping Hospital (Army Medical Center of PLA), Army Medical University, No. 10 Changjiang Branch Road, Yuzhong District, Chongqing, China
| | - X Yin
- Department of Spine Surgery, Center of Orthopedics, Daping Hospital (Army Medical Center of PLA), Army Medical University, No. 10 Changjiang Branch Road, Yuzhong District, Chongqing, China
| | - W Fan
- Department of Spine Surgery, Center of Orthopedics, Daping Hospital (Army Medical Center of PLA), Army Medical University, No. 10 Changjiang Branch Road, Yuzhong District, Chongqing, China
| | - J Zhu
- Department of Spine Surgery, Center of Orthopedics, Daping Hospital (Army Medical Center of PLA), Army Medical University, No. 10 Changjiang Branch Road, Yuzhong District, Chongqing, China
| | - J H Zhao
- Department of Spine Surgery, Center of Orthopedics, Daping Hospital (Army Medical Center of PLA), Army Medical University, No. 10 Changjiang Branch Road, Yuzhong District, Chongqing, China
| | - L Chen
- Laboratory for the Rehabilitation of Traumatic Injuries, Center of Bone Metabolism and Repair, State Key Laboratory of Trauma, Burns and Combined Injury, Trauma Center, Research Institute of Surgery, Daping Hospital (Army Medical Center of PLA), Army Medical University, Chongqing, China
| | - N Su
- Laboratory for the Rehabilitation of Traumatic Injuries, Center of Bone Metabolism and Repair, State Key Laboratory of Trauma, Burns and Combined Injury, Trauma Center, Research Institute of Surgery, Daping Hospital (Army Medical Center of PLA), Army Medical University, Chongqing, China
| | - Y Xie
- Laboratory for the Rehabilitation of Traumatic Injuries, Center of Bone Metabolism and Repair, State Key Laboratory of Trauma, Burns and Combined Injury, Trauma Center, Research Institute of Surgery, Daping Hospital (Army Medical Center of PLA), Army Medical University, Chongqing, China
| | - J Yang
- Laboratory for the Rehabilitation of Traumatic Injuries, Center of Bone Metabolism and Repair, State Key Laboratory of Trauma, Burns and Combined Injury, Trauma Center, Research Institute of Surgery, Daping Hospital (Army Medical Center of PLA), Army Medical University, Chongqing, China
| | - P Liu
- Department of Spine Surgery, Center of Orthopedics, Daping Hospital (Army Medical Center of PLA), Army Medical University, No. 10 Changjiang Branch Road, Yuzhong District, Chongqing, China.
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Blom AB, van den Bosch MH, Blaney Davidson EN, Roth J, Vogl T, van de Loo FA, Koenders M, van der Kraan PM, Geven EJ, van Lent PL. The alarmins S100A8 and S100A9 mediate acute pain in experimental synovitis. Arthritis Res Ther 2020; 22:199. [PMID: 32854769 PMCID: PMC7457270 DOI: 10.1186/s13075-020-02295-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 08/17/2020] [Indexed: 01/15/2023] Open
Abstract
Background Synovitis-associated pain is mediated by inflammatory factors that may include S100A8/9, which is able to stimulate nociceptive neurons via Toll-like receptor 4. In this study, we investigated the role of S100A9 in pain response during acute synovitis. Methods Acute synovitis was induced by streptococcal cell wall (SCW) injection in the knee joint of C57Bl/6 (WT) and S100A9−/− mice. The expression of S100A8/A9 was determined in serum and synovium by ELISA and immunohistochemistry. Inflammation was investigated by 99mTc accumulation, synovial cytokine release, and histology at days 1, 2, and 7. To assess pain, weight distribution, gait analysis, and mechanical allodynia were monitored. Activation markers in afferent neurons were determined by qPCR and immunohistochemistry in the dorsal root ganglia (DRG). Differences between groups were tested using a one-way or two-way analysis of variance (ANOVA). Differences in histology were tested with a non-parametric Mann–Whitney U test. p values lower than 0.05 were considered significant. Results Intra-articular SCW injection resulted in increased synovial expression and serum levels of S100A8/A9 at day 1. These increased levels, however, did not contribute to the development of inflammation, since this was equal in S100A9−/− mice. WT mice showed a significantly decreased percentage of weight bearing on the SCW hind paw on day 1, while S100A9−/− mice showed no reduction. Gait analysis showed increased “limping” behavior in WT, but not S100A9−/− mice. Mechanical allodynia was observed but not different between WT and S100A9−/− when measuring paw withdrawal threshold. The gene expression of neuron activation markers NAV1.7, ATF3, and GAP43 in DRG was significantly increased in arthritic WT mice at day 1 but not in S100A9−/− mice. Conclusions S100A8/9, released from the synovium upon inflammation, is an important mediator of pain response in the knee during the acute phase of inflammation.
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Affiliation(s)
- Arjen B Blom
- Experimental Rheumatology, Radboud university medical center, Geert Grooteplein 28, 6525 GA, Nijmegen, The Netherlands.
| | - Martijn H van den Bosch
- Experimental Rheumatology, Radboud university medical center, Geert Grooteplein 28, 6525 GA, Nijmegen, The Netherlands
| | - Esmeralda N Blaney Davidson
- Experimental Rheumatology, Radboud university medical center, Geert Grooteplein 28, 6525 GA, Nijmegen, The Netherlands
| | - Johannes Roth
- Institute of Immunology, University of Münster, Münster, Germany
| | - Thomas Vogl
- Institute of Immunology, University of Münster, Münster, Germany
| | - Fons A van de Loo
- Experimental Rheumatology, Radboud university medical center, Geert Grooteplein 28, 6525 GA, Nijmegen, The Netherlands
| | - Marije Koenders
- Experimental Rheumatology, Radboud university medical center, Geert Grooteplein 28, 6525 GA, Nijmegen, The Netherlands
| | - Peter M van der Kraan
- Experimental Rheumatology, Radboud university medical center, Geert Grooteplein 28, 6525 GA, Nijmegen, The Netherlands
| | - Edwin J Geven
- Experimental Rheumatology, Radboud university medical center, Geert Grooteplein 28, 6525 GA, Nijmegen, The Netherlands
| | - Peter L van Lent
- Experimental Rheumatology, Radboud university medical center, Geert Grooteplein 28, 6525 GA, Nijmegen, The Netherlands
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D’Amico R, Impellizzeri D, Cuzzocrea S, Di Paola R. ALIAmides Update: Palmitoylethanolamide and Its Formulations on Management of Peripheral Neuropathic Pain. Int J Mol Sci 2020; 21:ijms21155330. [PMID: 32727084 PMCID: PMC7432736 DOI: 10.3390/ijms21155330] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 07/23/2020] [Accepted: 07/24/2020] [Indexed: 02/06/2023] Open
Abstract
Neuropathic pain results from lesions or diseases of the somatosensory nervous system and it remains largely difficult to treat. Peripheral neuropathic pain originates from injury to the peripheral nervous system (PNS) and manifests as a series of symptoms and complications, including allodynia and hyperalgesia. The aim of this review is to discuss a novel approach on neuropathic pain management, which is based on the knowledge of processes that underlie the development of peripheral neuropathic pain; in particular highlights the role of glia and mast cells in pain and neuroinflammation. ALIAmides (autacoid local injury antagonist amides) represent a group of endogenous bioactive lipids, including palmitoylethanolamide (PEA), which play a central role in numerous biological processes, including pain, inflammation, and lipid metabolism. These compounds are emerging thanks to their anti-inflammatory and anti-hyperalgesic effects, due to the down-regulation of activation of mast cells. Collectively, preclinical and clinical studies support the idea that ALIAmides merit further consideration as therapeutic approach for controlling inflammatory responses, pain, and related peripheral neuropathic pain.
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Affiliation(s)
- Ramona D’Amico
- Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, University of Messina, Viale Ferdinando Stagno D’Alcontres 31, 98166 Messina, Italy; (R.D.); (D.I.); (R.D.P.)
| | - Daniela Impellizzeri
- Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, University of Messina, Viale Ferdinando Stagno D’Alcontres 31, 98166 Messina, Italy; (R.D.); (D.I.); (R.D.P.)
| | - Salvatore Cuzzocrea
- Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, University of Messina, Viale Ferdinando Stagno D’Alcontres 31, 98166 Messina, Italy; (R.D.); (D.I.); (R.D.P.)
- Department of Pharmacological and Physiological Science, Saint Louis University School of Medicine, 1402 South Grand Blvd, St Louis, MO 63104, USA
- Correspondence: ; Tel.: +39-90-6765208
| | - Rosanna Di Paola
- Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, University of Messina, Viale Ferdinando Stagno D’Alcontres 31, 98166 Messina, Italy; (R.D.); (D.I.); (R.D.P.)
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Females have greater susceptibility to develop ongoing pain and central sensitization in a rat model of temporomandibular joint pain. Pain 2020; 160:2036-2049. [PMID: 31430262 DOI: 10.1097/j.pain.0000000000001598] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Temporomandibular joint osteoarthritis (TMJOA) is a prevalent source of temporomandibular joint disorder (TMD). Women are more commonly diagnosed with TMD and are more likely to seek care at tertiary orofacial pain clinics. Limited knowledge regarding mechanisms underlying temporomandibular joint (TMJ) pain impairs development of improved pain management strategies. In a rat model of unilateral TMJOA, monosodium iodoacetate (MIA) produces joint pathology in a concentration-dependent manner. Unilateral MIA produces alterations in meal patterns in males and females without altering overnight time spent eating or weight across 2 weeks. Monosodium iodoacetate (80 mg/mL)-treated males develop ongoing pain within 2 weeks after MIA injection. Females develop ongoing pain at a 5-fold lower MIA concentration (16.6 mg/m). Monosodium iodoacetate (80 mg/mL)-treated males show spread of tactile hypersensitivity across the face during the first week after injection and then to the fore paws and hind paws during the second week after injection, indicating development of central sensitization. At the lower dose, female rats demonstrate a similar spread of tactile hypersensitivity, whereas male rats do not develop ongoing pain or spread of tactile hypersensitivity outside the area of the ipsilateral temporomandibular joint. These observations indicate that females have a higher susceptibility to development of ongoing pain and central sensitization compared with male rats that is not due to differences in MIA-induced joint pathology. This model of TMJOA pain can be used to explore sex differences in pain processes implicated in development of neuropathic pain, ongoing pain, and central sensitization, allowing for development of individualized strategies for prevention and treatment of TMD joint pain.
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van Reij RRI, Voncken JW, Joosten EAJ, van den Hoogen NJ. Polygenic risk scores indicates genetic overlap between peripheral pain syndromes and chronic postsurgical pain. Neurogenetics 2020; 21:205-215. [PMID: 32377986 PMCID: PMC7283206 DOI: 10.1007/s10048-020-00614-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 04/21/2020] [Indexed: 02/08/2023]
Abstract
Chronic postsurgical pain (CPSP) is a debilitating chronic pain condition that has a substantial effect on quality of life. CPSP shows considerable clinical overlap with different chronic peripheral pain syndromes, suggesting a shared aetiology. This study aims to assess the genetic overlap between different chronic pain syndromes and CPSP, providing relevant biological context for potential chronic pain markers of CPSP. To analyse the genetic overlap between CPSP and chronic peripheral pain syndromes, recent GWAS studies were combined for polygenic risk scores (PRS) analysis, using a cohort of CPSP patients as starting point. Biological contextualisation of genetic marker, overlap between CPSP and chronic pain syndromes, was assessed through Gene Ontology (GO), using Pathway Scoring Algorithm (PASCAL) and REVIGO. PRS analyses suggest a significant genetic overlap between CPSP and 3 chronic pain disorders: chronic widespread pain (CWP, p value threshold = 0.003, R2 0.06, p = 0.003), rheumatoid arthritis (RA, p value threshold = 0.0177, R2 = 0.04, p = 0.017) and possibly sciatica (p value threshold = 0.00025, R2 = 0.03, p = 0.045). Whereas no significant genetic overlap was found with cluster headache and migraine, the outcome for osteoarthritis (OA) was inconsistent between the cohorts. This is likely related to cohort composition, as repeated random reallocation of patients' nullified CPSP/OA outcome variation between the discovery and replication cohorts. GO analyses suggested an aetiological involvement of genetic markers that control neurological signalling (specifically sodium channels) and inflammatory response. The current study reaffirms the impact of sample size, cohort composition and open data accessibility on the unbiased identification of genetic overlap across disorders. In conclusion, this study is the first to report genetic overlap between regulatory processes implicated in CPSP and chronic peripheral pain syndromes. Interaction between neurological signalling and inflammatory response may explain the genetic overlap between CPSP, CWP and RA. Enhanced understanding of mechanisms underlying chronification of pain will aid the development of new therapeutic strategies for CPSP with sodium channel biochemistry as a potential candidate.
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Affiliation(s)
- Roel R I van Reij
- Department of Anaesthesiology and Pain Management, Maastricht University Medical Center+, 6200, MD, Maastricht, The Netherlands.
- Department of Translational Neuroscience, School for Mental Health and Neuroscience (MHeNs), University of Maastricht, 6200, MD, Maastricht, The Netherlands.
| | - Jan Willem Voncken
- Department of Molecular Genetics, Maastricht University Medical Center+, 6200, MD, Maastricht, The Netherlands
| | - Elbert A J Joosten
- Department of Anaesthesiology and Pain Management, Maastricht University Medical Center+, 6200, MD, Maastricht, The Netherlands
- Department of Translational Neuroscience, School for Mental Health and Neuroscience (MHeNs), University of Maastricht, 6200, MD, Maastricht, The Netherlands
| | - Nynke J van den Hoogen
- Department of Anaesthesiology and Pain Management, Maastricht University Medical Center+, 6200, MD, Maastricht, The Netherlands
- Department of Translational Neuroscience, School for Mental Health and Neuroscience (MHeNs), University of Maastricht, 6200, MD, Maastricht, The Netherlands
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Tanaka R, Hirohama K, Kurashige Y, Mito K, Miyamoto S, Masuda R, Morita T, Yokota S, Sato S. Prediction models considering psychological factors to identify pain relief in conservative treatment of people with knee osteoarthritis: A multicenter, prospective cohort study. J Orthop Sci 2020; 25:618-626. [PMID: 31383387 DOI: 10.1016/j.jos.2019.06.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 03/11/2019] [Accepted: 06/19/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Pain-related affective and/or cognitive characteristics such as depressive symptoms, pain catastrophizing, and self-efficacy are known to exacerbate pain in people with knee osteoarthritis. However, no studies have investigated whether these psychological factors can interfere with pain relief during conservative treatment. The object of this study was to assess the prediction models considering psychological factors to predict pain relief in people with knee osteoarthritis receiving conservative treatment. METHODS Study design was a multicenter, and prospective cohort study. Data were collected in the department of physical therapy in 1 hospital and 7 orthopedic clinics. Eighty-eight people with knee osteoarthritis participated in this study and were followed for 3 months. The numeric rating scale and the Knee Injury and Osteoarthritis Outcome Score scale were used to evaluate pain relief. Potential predictors for pain relief were depressive symptoms, self-efficacy, and pain catastrophizing. The classification and regression trees methodology was used to develop the model for predicting the presence of pain relief at 1 and 3 months after the start of observation. The prediction accuracy was evaluated using the area under the receiver operating characteristic curves (AUCs). RESULTS The model at 1 month after the start of observation included pain intensity at baseline, positive affect, and disease duration. The AUC of this model was 0.793 (95% confidential interval, 0.687-0.898). The model at 3 months after the start of observation included pain catastrophizing and self-efficacy. The AUC of this model was 0.808 (95% confidential interval, 0.682-0.934). CONCLUSIONS The accuracy of prediction model considering pain-related affective and/or cognitive characteristics is moderate for pain relief in people with knee osteoarthritis receiving conservative treatment.
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Affiliation(s)
- Ryo Tanaka
- Graduate School of Integrated Arts and Sciences, Hiroshima University, Hiroshima, Japan; Department of Rehabilitation, Hiroshima International University, Hiroshima, Japan.
| | - Kenta Hirohama
- Department of Rehabilitation, Sakamidorii Hospital, Hiroshima, Japan
| | - Yuki Kurashige
- Department of Rehabilitation, Hatano Rehabilitation Orthopaedic Clinic, Hiroshima, Japan
| | - Kenichiro Mito
- Department of Rehabilitation, Okamoto Orthopaedics and Sports Clinic, Hiroshima, Japan
| | - Shintaro Miyamoto
- Department of Rehabilitation, Ota Orthopaedics and Onari Respiratory Clinic, Hiroshima, Japan
| | - Ryosuke Masuda
- Department of Rehabilitation, Hiramatsu Orthopedic Clinic, Hiroshima, Japan
| | - Tetsushi Morita
- Department of Rehabilitation, Asahi Orthopedic Clinic, Hiroshima, Japan
| | - Shinichi Yokota
- Department of Rehabilitation, Yasumoto Clinic, Hiroshima, Japan
| | - Seisuke Sato
- Department of Rehabilitation, Wako Orthopedic and Sports Clinic, Hiroshima, Japan
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Caraci F, Coluzzi F, Marinangeli F, Mercadante S, Rinonapoli G, Romualdi P, Nicora M, Dickenson AH. Modulation of sensitization processes in the management of pain and the importance of descending pathways: a role for tapentadol? Curr Med Res Opin 2020; 36:1015-1024. [PMID: 32216591 DOI: 10.1080/03007995.2020.1748876] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Objective: This paper presents and discusses recent evidence on the pathophysiological mechanisms of pain. The role of tapentadol - an opioid characterized by an innovative mechanism of action (i.e. µ-opioid receptor [MOR] agonism and inhibition of noradrenaline [NA] reuptake [NRI]) - in the modulation of pain, and the most recent pharmacological evidence on this molecule (e.g. the µ-load concept) are also presented and commented upon.Methods: Narrative review.Results: Solid evidence has highlighted the importance of central sensitization in the transition from acute to chronic pain. In particular, the noradrenergic system holds a major role in limiting central sensitization and the progression to chronic pain. Therefore, pharmacological modulation of the noradrenergic system appears to be a well-grounded strategy for the control of chronic pain. Tapentadol is characterized by a to-date-unique mechanism of action, since it acts both as a MOR agonist and as an inhibitor of NA reuptake. The synergistic interaction of these two mechanisms allows a strong analgesic effect by acting on both ascending and descending pathways. Of note, the reduced µ-load of tapentadol limits the risk of opioid-related adverse events, such as gastrointestinal disturbances. Moreover, the NA component becomes predominant, at least, in some types of pain, with consequent specific clinical efficacy in the treatment of neuropathic and chronic pain.Conclusions: According to these characteristics, tapentadol appears suitable in the treatment of severe uncontrolled chronic pain characterized by both a nociceptive and a neuropathic component, such as osteoarthritis or back pain.
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Affiliation(s)
- Filippo Caraci
- Department of Drug Sciences, University of Catania, Catania, Italy
- Oasi Research Institute - IRCCS, Troina, Italy
| | - Flaminia Coluzzi
- Department of Medical and Surgical Sciences and Biotechnologies, Sapienza University of Rome, Rome, Italy
| | - Franco Marinangeli
- Anesthesiology and Intensive Care, University of L'Aquila, L'Aquila, Italy
| | - Sebastiano Mercadante
- Supportive Care Center, MD Anderson Cancer Center, University of Texas, Houston, Texas, USA
- Main Regional Center for Pain Relief and Supportive/Palliative Care, La Maddalena Cancer Center, Palermo, Italy
| | | | - Patrizia Romualdi
- Department of Pharmacy and Biotechnology, Alma Mater Studiorum, University of Bologna, Bologna, Italy
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Chen CH, Kuo SM, Tien YC, Shen PC, Kuo YW, Huang HH. Steady Augmentation of Anti-Osteoarthritic Actions of Rapamycin by Liposome-Encapsulation in Collaboration with Low-Intensity Pulsed Ultrasound. Int J Nanomedicine 2020; 15:3771-3790. [PMID: 32547027 PMCID: PMC7266395 DOI: 10.2147/ijn.s252223] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Introduction Rapamycin has been considered as a potential treatment for osteoarthritis (OA). Drug carriers fabricated from liposomes can prolong the effects of drugs and reduce side effects of drugs. Low-intensity pulsed ultrasound (LIPUS) has been found to possess anti-OA effects. Materials and Methods The anti-osteoarthritic effects of liposome-encapsulated rapamycin (L-rapa) combined with LIPUS were examined by culture of normal and OA chondrocytes in alginate beads and further validated in OA prone Dunkin-Hartley guinea pigs. Results L-rapa with LIPUS largely up-regulated aggrecan and type II collagen mRNA in human OA chondrocytes (HOACs). L-rapa with LIPUS caused significant enhancement in proteoglycan and type II collagen production in HOACs. Large decreases in both MMP-13 and IL-6 proteins were found in the HOACs exposed to L-rapa with LIPUS. Intra-articular injection of 40 μL L-rapa at both 5 μM and 50 μM twice a week combined with LIPUS thrice a week for 8 weeks significantly increased GAGs and type II collagen in the cartilage of knee. Results on OARSI score showed that intra-articular injection of 5 μM L-rapa with LIPUS displayed the greatest anti-OA effects. Immunohistochemistry revealed that L-rapa with or without LIPUS predominantly reduced MMP-13 in vivo. The values of complete blood count and serum biochemical examinations remained in the normal ranges after the injections with or without LIPUS. These data indicated that intra-articular injection of L-rapa collaborated with LIPUS is not only effective against OA but a safe OA therapy. Conclusion Taken together, L-rapa combined with LIPUS possessed the most consistently and effectively anabolic and anti-catabolic effects in HOACs and the spontaneous OA guinea pigs. This study evidently revealed that liposome-encapsulation collaborated with LIPUS is able to reduce the effective dose and administration frequency of rapamycin and further stably reinforce its therapeutic actions against OA.
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Affiliation(s)
- Chung-Hwan Chen
- Department of Orthopedics and Orthopedic Research Center, Kaohsiung Municipal Ta-Tung Hospital and Kaohsiung Medical University Hospital, College of Medicine, Kaohsiung Medical University, Kaohsiung City 80708, Taiwan.,Institute of Medical Science and Technology, National Sun Yat-Sen University, Kaohsiung City 80424, Taiwan
| | - Shyh Ming Kuo
- Department of Biomedical Engineering, I-Shou University, Kaohsiung City 82445, Taiwan
| | - Yin-Chun Tien
- Department of Orthopedics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung City 80708, Taiwan.,Department of Orthopedics, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
| | - Po-Chih Shen
- Department of Orthopedics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung City 80708, Taiwan
| | - Yi-Wen Kuo
- Orthopedic Research Center, Kaohsiung Medical University, Kaohsiung City 80708, Taiwan
| | - Han Hsiang Huang
- Department of Veterinary Medicine, National Chiayi University, Chiayi City 60054, Taiwan
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83
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Caraci F, Coluzzi F, Marinangeli F, Mercadante S, Rinonapoli G, Romualdi P, Nicora M, Dickenson AH. Modulation of sensitization processes in the management of pain and the importance of descending pathways: a role for tapentadol? Curr Med Res Opin 2020; 36:I-XVII. [PMID: 31822137 DOI: 10.1080/03007995.2019.1703664] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Objective: This paper presents and discusses recent evidence on the pathophysiological mechanisms of pain. The role of tapentadol - an analgesic molecule characterized by an innovative mechanism of action (i.e. µ-opioid receptor [MOR] agonism and inhibition of noradrenaline [NA] reuptake [NRI]) - in the modulation of pain, and the most recent pharmacological evidence on this molecule (e.g. the µ-load concept) are also presented and commented upon.Methods: Narrative review.Results: Solid evidence has highlighted the importance of central sensitization in the transition from acute to chronic pain. In particular, the noradrenergic system holds a major role in limiting central sensitization and the progression to chronic pain. Therefore, pharmacological modulation of the noradrenergic system appears to be a well-grounded strategy for the control of chronic pain. Tapentadol is characterized by a to-date-unique mechanism of action since it acts both as a MOR agonist and as an inhibitor of NA reuptake. The synergistic interaction of these two mechanisms allows a strong analgesic effect by acting on both ascending and descending pathways. Of note, the reduced µ-load of tapentadol has two important consequences: first, it limits the risk of opioid-related adverse events, as well as the risk of dependence; second, the NA component becomes predominant at least in some types of pain with consequent specific clinical efficacy in the treatment of neuropathic and chronic pain.Conclusions: According to these characteristics, tapentadol appears suitable in the treatment of chronic pain conditions characterized by both a nociceptive and a neuropathic component, such as osteoarthritis or back pain.
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Affiliation(s)
- Filippo Caraci
- Department of Drug Sciences, University of Catania, Catania, Italy
- Oasi Research Institute - IRCCS, Troina, Italy
| | - Flaminia Coluzzi
- Department of Medical and Surgical Sciences and Biotechnologies, Sapienza University of Rome, Rome, Italy
| | - Franco Marinangeli
- Anesthesiology and Intensive Care, University of L'Aquila, L'Aquila, Italy
| | - Sebastiano Mercadante
- Supportive Care Center, MD Anderson Cancer Center, University of Texas, Houston, Texas, USA
- Main Regional Center for Pain Relief and Supportive/Palliative Care, La Maddalena Cancer Center, Palermo, Italy
| | | | - Patrizia Romualdi
- Department of Pharmacy and Biotechnology, Alma Mater Studiorum, University of Bologna, Bologna, Italy
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Mineral rich algae with pine bark improved pain, physical function and analgesic use in mild-knee joint osteoarthritis, compared to Glucosamine: A randomized controlled pilot trial. Complement Ther Med 2020; 50:102349. [DOI: 10.1016/j.ctim.2020.102349] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 01/15/2020] [Accepted: 02/17/2020] [Indexed: 12/17/2022] Open
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Changes of Somatosensory Phenotype in the Course of Disease in Osteoarthritis Patients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17093085. [PMID: 32365479 PMCID: PMC7246567 DOI: 10.3390/ijerph17093085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 04/16/2020] [Accepted: 04/22/2020] [Indexed: 01/21/2023]
Abstract
To investigate sensory changes, physical function (pF), quality of life (QoL) and pain intensity of patients with osteoarthritis (OA) in the natural course of disease, and patients undergoing total joint replacement therapy (TJR) 31 (20 females, mean age 64.6 ± 10.4 years), patients with OA were investigated with questionnaires and quantitative sensory testing (QST) in the area of referred pain at the thigh at baseline and follow-up 22–49 weeks later; changes were analyzed separately for patients with (n = 13) and without TJR (n = 18). In patients without TJR pain intensity, pF, QoL did not improve, and increased pain sensitivity to cold and a stronger loss of detection were observed. In patients after TJR, however, a reduction in mechanical pain sensitivity and allodynia occurred in accordance with a reduction of pain intensity and improvement of functionality while QoL did not improve. Additionally, an increased sensitivity to heat pain and a more pronounced loss of mechanical detection could be observed in this group. TJR seems to stop peripheral pain input leading to a reduction of pain intensity and central sensitization, but surgery-induced sensory changes such as peripheral sensitization and loss of detection occur. Furthermore, TJR has favorable effects on pain intensity and functionality but not QoL.
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86
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Lockwood S, Dickenson AH. What goes up must come down: insights from studies on descending controls acting on spinal pain processing. J Neural Transm (Vienna) 2020; 127:541-549. [PMID: 31515656 PMCID: PMC7148257 DOI: 10.1007/s00702-019-02077-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 09/03/2019] [Indexed: 12/25/2022]
Abstract
Descending controls link higher processing of noxious signals to modulation of spinal cord responses to their noxious inputs. It has become possible to study one key inhibitory system in animals and humans using one painful stimulus to attenuate another distant response and so eliciting diffuse noxious inhibitory controls (DNIC) or the human counterpart, conditioned pain modulation (CPM). Here, we discuss the neuronal pathways in both species, their pharmacology and examine changes in descending controls with a focus on osteoarthritis. We will also discuss the opposing descending facilitatory system. Strong parallels between DNIC and CPM emphasize the possibility of forward and reverse translation.
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Affiliation(s)
- Stevie Lockwood
- Department of Neuroscience, Physiology and Pharmacology, University College London, Gower St., London, WC1E6BT, UK
| | - Anthony H Dickenson
- Department of Neuroscience, Physiology and Pharmacology, University College London, Gower St., London, WC1E6BT, UK.
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87
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Li L, Li Z, Li Y, Hu X, Zhang Y, Fan P. Profiling of inflammatory mediators in the synovial fluid related to pain in knee osteoarthritis. BMC Musculoskelet Disord 2020; 21:99. [PMID: 32059658 PMCID: PMC7023718 DOI: 10.1186/s12891-020-3120-0] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Accepted: 02/06/2020] [Indexed: 01/22/2023] Open
Abstract
Background Inflammatory mediators in the synovial fluid (SF) play critical roles in the initiation and development of pain in knee osteoarthritis (KOA). However, data for inflammatory marker expression are conflicting, and the role of SF inflammatory mediators in neuropathic pain is not clear. Therefore, the aim of this study was to identify SF inflammatory mediators associated with nociceptive and neuropathic pain in KOA. Methods Levels of IL-1β, IL-6, TNF-α, macrophage colony-stimulating factor, MMP-3, MMP-13, metalloproteinase with thrombospondin motifs 5, calcitonin gene-related peptide, neuropeptide Y, substance P and bradykinin were measured using enzyme-linked immunosorbent assays in 86 patients. Nociceptive pain was assessed using the numeric rating scale (NRS), visual analog scale (VAS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain score. Neuropathic pain was determined using the PainDETECT questionnaire. Moreover, knee function was evaluated by the WOMAC score and range of motion (ROM) assessments. Radiological grade was defined using the Kellgren-Lawrence (K-L) grading scale. Results Pain scores measured using different methods correlated highly with each other. A worse K-L grade and knee function were associated with worse pain. Expression of IL-1β and IL-6 was increased in the early stage compared with the late stage. The NRS score correlated positively with age, K-L grade, and the WOMAC score and negatively with ROM and TNF-α expression. The VAS correlated positively with age, K-L grade, and the WOMAC score but negatively with ROM and levels of IL-1β, IL-6 and TNF-α. The WOMAC pain score did not correlate with any of the inflammatory mediators measured; it correlated only with ROM. The PainDETECT score correlated only with the WOMAC score. Expression of other inflammatory mediators did not correlate with any of the pain scores. Conclusions IL-1β, IL-6 and TNF-α play critical roles in pain in the early stage of KOA and correlate with pain. The catabolic enzymes and neuropeptides measured do not correlate with nociceptive and neuropathic pain. New biomarkers related to pain in the late stage need to be further investigated.
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Affiliation(s)
- Li Li
- Zhejiang Provincial Key Laboratory of Anesthesiology, The Second Affiliated Hospital of Wenzhou Medical University, Yuying Children's Hospital, Wenzhou, China.,Department of Anesthesiology, The Second Affiliated Hospital of Wenzhou Medical University, Yuying Children's Hospital, Wenzhou, China
| | - Zhenxing Li
- Department of Orthopedics, The Second Affiliated Hospital of Wenzhou Medical University, Yuying Children's Hospital, No.109, Xueyuan West Road, Wenzhou, China
| | - Yuyan Li
- Department of Orthopedics, The Second Affiliated Hospital of Wenzhou Medical University, Yuying Children's Hospital, No.109, Xueyuan West Road, Wenzhou, China
| | - Xi Hu
- Department of Orthopedics, The Second Affiliated Hospital of Wenzhou Medical University, Yuying Children's Hospital, No.109, Xueyuan West Road, Wenzhou, China
| | - Yu Zhang
- Department of Orthopedics, The Second Affiliated Hospital of Wenzhou Medical University, Yuying Children's Hospital, No.109, Xueyuan West Road, Wenzhou, China
| | - Pei Fan
- Department of Orthopedics, The Second Affiliated Hospital of Wenzhou Medical University, Yuying Children's Hospital, No.109, Xueyuan West Road, Wenzhou, China. .,Zhejiang Provincial Key Laboratory of Orthopedics, The Second Affiliated Hospital of Wenzhou Medical University, Yuying Children's Hospital, No.109, Xueyuan West Road, Wenzhou, China.
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Kawarai Y, Orita S, Nakamura J, Miyamoto S, Suzuki M, Inage K, Hagiwara S, Suzuki T, Nakajima T, Akazawa T, Ohtori S. Analgesic Effect of Duloxetine on an Animal Model of Monosodium Iodoacetate-Induced Hip Osteoarthritis. J Orthop Res 2020; 38:422-430. [PMID: 31538672 DOI: 10.1002/jor.24480] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 09/13/2019] [Indexed: 02/04/2023]
Abstract
We investigated the efficacy of duloxetine on hyperalgesia, histopathological and radiographic findings, pain-related sensory innervation of dorsal-root ganglia (DRG), and spinal changes in a rat model of induced hip osteoarthritis (OA). The right hip joints of male Sprague-Dawley rats (n = 6 rats/group) in the Sham group were injected with 25 μl of sterile saline and 25 μl of sterile saline with 2 mg of monosodium iodoacetate (MIA) were injected to the MIA + Vehicle and MIA + Duloxetine groups. We injected duloxetine 20 mg/kg intraperitoneally in the MIA + Duloxetine group 28 days after injection, whereas rats in the MIA + Vehicle group were injected with 0.5 ml of 20% dimethyl sulfoxide. We assessed hyperalgesia, histopathological changes, immunoreactive (-ir) neurons for calcitonin gene-related peptide and activating transcription factor 3 in DRG, and immunoreactive neurons for ionized-calcium-binding adaptor molecule 1 (Iba1) in the dorsal horn of the spinal cord. MIA administration into the hip joint let to mechanical hyperalgesia of the ipsilateral hind paw (p < 0.05). A single injection of duloxetine significantly attenuated it in induced hip OA (p < 0.05) and suppressed the number of Iba1-ir microglia of the ipsilateral dorsal horn (p < 0.05). These results suggest that a single injection of duloxetine suppressed mechanical hyperalgesia and may influence the expression of Iba1 in the microglia of the ipsilateral dorsal horn in the MIA-induced hip OA. This finding implies the inhibitory effects of duloxetine against neuropathic pain, which may lead to a change of microglial activities. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 38:422-430, 2020.
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Affiliation(s)
- Yuya Kawarai
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba, 260-8677, Japan
| | - Sumihisa Orita
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba, 260-8677, Japan
| | - Junichi Nakamura
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba, 260-8677, Japan
| | - Shuichi Miyamoto
- Department of Orthopaedic Surgery, Matsudo City General Hospital, 993-1 Sendabori, Matsudo, Chiba, 270-2296, Japan
| | - Miyako Suzuki
- Department of Bioenvironmental Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8677, Japan
| | - Kazuhide Inage
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba, 260-8677, Japan
| | - Shigeo Hagiwara
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba, 260-8677, Japan
| | - Takane Suzuki
- Department of Bioenvironmental Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8677, Japan
| | - Takayuki Nakajima
- Department of Orthopaedic Surgery, Eastern Chiba Medical Center, 3-6-2 Okayamadai, Togane, Chiba, 283-8686, Japan
| | - Tsutomu Akazawa
- Department of Orthopaedic Surgery, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa, 216-8511, Japan
| | - Seiji Ohtori
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba, 260-8677, Japan
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Cordaro M, Siracusa R, Impellizzeri D, D' Amico R, Peritore AF, Crupi R, Gugliandolo E, Fusco R, Di Paola R, Schievano C, Cuzzocrea S. Safety and efficacy of a new micronized formulation of the ALIAmide palmitoylglucosamine in preclinical models of inflammation and osteoarthritis pain. Arthritis Res Ther 2019; 21:254. [PMID: 31779692 PMCID: PMC6883534 DOI: 10.1186/s13075-019-2048-y] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 11/01/2019] [Indexed: 12/21/2022] Open
Abstract
Background Osteoarthritis is increasingly recognized as the result of a complex interplay between inflammation, chrondrodegeneration, and pain. Joint mast cells are considered to play a key role in orchestrating this detrimental triad. ALIAmides down-modulate mast cells and more generally hyperactive cells. Here we investigated the safety and effectiveness of the ALIAmide N-palmitoyl-d-glucosamine (PGA) in inflammation and osteoarthritis pain. Methods Acute toxicity of micronized PGA (m-PGA) was assessed in rats following OECD Guideline No.425. PGA and m-PGA (30 mg/kg and 100 mg/kg) were orally administered to carrageenan (CAR)-injected rats. Dexamethasone 0.1 mg/kg was used as reference. Paw edema and thermal hyperalgesia were measured up to 6 h post-injection, when also myeloperoxidase activity and histological inflammation score were assessed. Rats subjected to intra-articular injection of sodium monoiodoacetate (MIA) were treated three times per week for 21 days with PGA or m-PGA (30 mg/kg). Mechanical allodynia and motor function were evaluated at different post-injection time points. Joint histological and radiographic damage was scored, articular mast cells were counted, and macrophages were immunohistochemically investigated. Levels of TNF-α, IL-1β, NGF, and MMP-1, MMP-3, and MMP-9 were measured in serum using commercial colorimetric ELISA kits. One- or two-way ANOVA followed by a Bonferroni post hoc test for multiple comparisons was used. Results Acute oral toxicity of m-PGA resulted in LD50 values in excess of 2000 mg/kg. A single oral administration of PGA and m-PGA significantly reduced CAR-induced inflammatory signs (edema, inflammatory infiltrate, and hyperalgesia), and m-PGA also reduced the histological score. Micronized PGA resulted in a superior activity to PGA on MIA-induced mechanical allodynia, locomotor disability, and histologic and radiographic damage. The MIA-induced increase in mast cell count and serum level of the investigated markers was also counteracted by PGA and to a significantly greater extent by m-PGA. Conclusions The results of the present study showed that PGA is endorsed with anti-inflammatory, pain-relieving, and joint-protective effects. Moreover, it proved that particle size reduction greatly enhances the activity of PGA, particularly on joint pain and disability. Given these results, m-PGA could be considered a valuable option in the management of osteoarthritis.
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Affiliation(s)
- Marika Cordaro
- Department of Chemical, Biological, Pharmaceutical and Environmental Science, University of Messina, Messina, Italy
| | - Rosalba Siracusa
- Department of Chemical, Biological, Pharmaceutical and Environmental Science, University of Messina, Messina, Italy
| | - Daniela Impellizzeri
- Department of Chemical, Biological, Pharmaceutical and Environmental Science, University of Messina, Messina, Italy
| | - Ramona D' Amico
- Department of Chemical, Biological, Pharmaceutical and Environmental Science, University of Messina, Messina, Italy
| | - Alessio Filippo Peritore
- Department of Chemical, Biological, Pharmaceutical and Environmental Science, University of Messina, Messina, Italy
| | - Rosalia Crupi
- Department of Chemical, Biological, Pharmaceutical and Environmental Science, University of Messina, Messina, Italy
| | - Enrico Gugliandolo
- Department of Chemical, Biological, Pharmaceutical and Environmental Science, University of Messina, Messina, Italy
| | - Roberta Fusco
- Department of Chemical, Biological, Pharmaceutical and Environmental Science, University of Messina, Messina, Italy
| | - Rosanna Di Paola
- Department of Chemical, Biological, Pharmaceutical and Environmental Science, University of Messina, Messina, Italy
| | - Carlo Schievano
- Innovative Statistical Research srl, Prato Della Valle 24, I-35123, Padova, Italy
| | - Salvatore Cuzzocrea
- Department of Chemical, Biological, Pharmaceutical and Environmental Science, University of Messina, Messina, Italy. .,Department of Pharmacological and Physiological Science, Saint Louis University School of Medicine, Saint Louis, USA.
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López-López CO, Montes Castillo MDLL, Soto-Fajardo RC, Sandoval-García LF, Loyola-Sánchez A, Burgos-Vargas R, Peláez-Ballestas I, Álvarez Hernández E, Vázquez-Mellado J. Peripheral neuropathies in rheumatic diseases: More diverse and frequent than expected. A cross-sectional study. Int J Rheum Dis 2019; 23:226-232. [PMID: 31762210 DOI: 10.1111/1756-185x.13755] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 10/29/2019] [Accepted: 11/04/2019] [Indexed: 12/24/2022]
Abstract
BACKGROUND/OBJECTIVE Peripheral neuropathies (PN) are heterogeneous nerve disorders; frequently rheumatic patients have neuropathic symptoms. In some rheumatic diseases (RD) PN are secondary to nerve compression while others are related to metabolic abnormalities, inflammation or vasculitis. Our aim was to explore the frequency of neuropathic symptoms with three neuropathy questionnaires (NQ) and nerve conduction studies (NCS) in RD. METHODS This is a cross-sectional study in patients with any RD attending for the first time to a rheumatology outpatient clinic. We included all patients who accepted to participate and who answered three NQ and received a physical evaluation. Twenty patients were randomly selected to perform NCS and 10 healthy subjects were included as controls. The topographic diagnoses were: mononeuropathy, multiplex mononeuropathy, and/or polyneuropathy. STATISTICAL ANALYSIS descriptive statistics (mean, median, standard deviation, interquartile range and frequency, odds ratios and Pearson correlation test). RESULTS One hundred patients and 10 healthy subjects were included. Sixty-nine were female, mean age 40.6 ± 15.7 years. Rheumatic diagnoses were: systemic lupus erythematosus (26%), rheumatoid arthritis (16%), gout (14%), and osteoarthritis (11%). Fifty-two patients had neuropathic signs during physical examination and 67% had positive questionnaires with variable scores among several RD. Abnormal NCS was reported in 14 patients (70%): 6 (42.8%) median nerve mononeuropathies, 4 (28.5%) multiplex mononeuropathies and 4 (28.5%) polyneuropathies. None of the healthy subjects had neuropathy (NQ, physical evaluation, or NCS). Risk of being NCS positive is higher when the patients were NQ positive. CONCLUSION PN has variable distribution and high frequency in patients with RD; NQ+ increases the risk of presenting NCS+ for PN.
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Gao SH, Huo JB, Pan QM, Li XW, Chen HY, Huang JH. The short-term effect and safety of duloxetine in osteoarthritis: A systematic review and meta-analysis. Medicine (Baltimore) 2019; 98:e17541. [PMID: 31689755 PMCID: PMC6946455 DOI: 10.1097/md.0000000000017541] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Previous clinical trials indicated that duloxetine may be effective in the treatment of osteoarthritis (OA) pain. This meta-analysis is conducted to evaluate short term analgesic effect and safety of duloxetine in the treatment of OA. METHODS Electronic databases were searched in February 2019, including PUBMED, EMBASE, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, Web of Science. All eligible studies should be randomized controlled trials (RCTs) comparing duloxetine treatment group to placebo about OA pain relief and safety outcomes. RESULTS Five RCTs with 2059 patients were involved in this systematic review and meta-analysis. Compared to placebo, duloxetine treatment showed significant better result, with higher reduction pain intensity (mean difference [MD] = -0.77, P < .00001), higher rates of both 30% and 50% reduction in pain severity (risk ratio [RR] = 1.42, P < .00001; RR = 1.62, P < .00001), lower mean Patient Global Improvement-Inventory (PGI-I) score (MD = -0.48, P < .00001). The results of the Western Ontario and McMaster Universities (WOMAC) score change from baseline to endpoint also favored duloxetine treatment group in all four categories, including total (MD = -5.43, P < .00001), pain (MD = -1.63, P = .001), physical function (MD = -4.22, P < .00001), and stiffness score (MD = -0.58, P < .00001). There were higher rates of treatment-emergent adverse events (TEAEs) (RR = 1.32, P < .00001) and discontinuation (RR = 1.88, P < .00001) in duloxetine group. However, there was no significant difference in the incidence of severe adverse events (SAEs) between these 2 groups (RR = 0.84, P = .68). CONCLUSION Duloxetine was an effective and safe choice to improve pain and functional outcome in OA patients. However, further studies are still needed to find out the optimal dosage for OA and examine its long-term efficacy and safety. TRIAL REGISTRATION NUMBER CRD42019128862.
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Anand P, Dickenson A, Finco G, Marinangeli F, Polati E, Romualdi P, Tzschentke TM, Canonico PL. Novel insights on the management of pain: highlights from the ‘Science of Relief’ meeting. Pain Manag 2019; 9:521-533. [DOI: 10.2217/pmt-2019-0031] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
The ‘Science of Relief’ event, held in Milan on 10–11 May 2019, was aimed at promoting dialog between different stakeholders among scientific associations, pharma industry, healthcare services and related institutions. The goal was to renew interest and attention on the management of pain, sharing new solutions in order to bring the patients and their quality of life to the center of attention. An international group of scientists and clinicians presented and discussed new and known evidence in the field of chronic pain, from physiopathology and diagnosis to the choice of appropriate and timely pharmacological treatments. This paper reports the highlights of those presentations.
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Affiliation(s)
- Praveen Anand
- Department of Neurology, Imperial College London, Hammersmith Hospital, London, UK
| | | | - Gabriele Finco
- Dipartimento di Scienze Mediche e Sanità Pubblica, Università degli Studi di Cagliari. UOC Anestesia e Rianimazione, Centro Terapia del Dolore Azienda Ospedaliero-Universitaria di Cagliari
| | - Franco Marinangeli
- Dipartimento di Medicina clinica, Università degli Studi, Sanità pubblica, Scienza della vita e dell’ambiente dell’Aquila
| | - Enrico Polati
- Anestesia, Rianimazione e Terapia del Dolore, Università di Verona, Verona, Italy
| | - Patrizia Romualdi
- Dipartimento di Farmacia e Biotecnologie, Università di Bologna, Bologna
| | | | - Pier Luigi Canonico
- Dipartimento di Scienze del Farmaco, Università del Piemonte Orientale “Amedeo Avogadro”, Novara, Italy
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Kompel AJ, Roemer FW, Murakami AM, Diaz LE, Crema MD, Guermazi A. Intra-articular Corticosteroid Injections in the Hip and Knee: Perhaps Not as Safe as We Thought? Radiology 2019; 293:656-663. [PMID: 31617798 DOI: 10.1148/radiol.2019190341] [Citation(s) in RCA: 158] [Impact Index Per Article: 31.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Osteoarthritis (OA) of the hip and knee is among the most common joint disorders. Intra-articular corticosteroid (IACS) injections are frequently performed to treat OA and other joint-related pain syndromes; however, there is conflicting evidence on their potential benefit. There is a lack of prospective and large retrospective studies evaluating potential joint findings, including increased risk for accelerated OA progression or adverse joint events, after treatment with IACS injection. Four main adverse joint findings have been structurally observed in patients after IACS injections: accelerated OA progression, subchondral insufficiency fracture, complications of osteonecrosis, and rapid joint destruction, including bone loss. Physicians, including radiologists, should be familiar with imaging findings and patient characteristics that may help them identify potential joints at risk for such events. The purpose of this report is to review the existing literature, describe observed adverse joint events after IACS injections, and provide an outlook on how this may affect clinical practice. Additional research endeavors are urgently needed to better understand and identify risk factors prior to intervention and to detect adverse joint events after injection as early as possible to prevent or minimize complications.
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Affiliation(s)
- Andrew J Kompel
- From the Department of Radiology, Boston University School of Medicine, 820 Harrison Ave, FGH Building, 3rd Floor, Boston, MA 02118 (A.J.K., F.W.R., A.M.M., L.E.D., M.D.C., A.G.); Department of Radiology, Friedrich-Alexander University Erlangen-Nürnberg (FAU) and University Hospital Erlangen, Erlangen, Germany (F.W.R.); Department of Radiology, Veterans Affairs Hospital, Boston, Mass (L.E.D., A.G.); and Institute of Sports Imaging, French National Institute of Sports (INSEP), Paris, France (M.D.C.)
| | - Frank W Roemer
- From the Department of Radiology, Boston University School of Medicine, 820 Harrison Ave, FGH Building, 3rd Floor, Boston, MA 02118 (A.J.K., F.W.R., A.M.M., L.E.D., M.D.C., A.G.); Department of Radiology, Friedrich-Alexander University Erlangen-Nürnberg (FAU) and University Hospital Erlangen, Erlangen, Germany (F.W.R.); Department of Radiology, Veterans Affairs Hospital, Boston, Mass (L.E.D., A.G.); and Institute of Sports Imaging, French National Institute of Sports (INSEP), Paris, France (M.D.C.)
| | - Akira M Murakami
- From the Department of Radiology, Boston University School of Medicine, 820 Harrison Ave, FGH Building, 3rd Floor, Boston, MA 02118 (A.J.K., F.W.R., A.M.M., L.E.D., M.D.C., A.G.); Department of Radiology, Friedrich-Alexander University Erlangen-Nürnberg (FAU) and University Hospital Erlangen, Erlangen, Germany (F.W.R.); Department of Radiology, Veterans Affairs Hospital, Boston, Mass (L.E.D., A.G.); and Institute of Sports Imaging, French National Institute of Sports (INSEP), Paris, France (M.D.C.)
| | - Luis E Diaz
- From the Department of Radiology, Boston University School of Medicine, 820 Harrison Ave, FGH Building, 3rd Floor, Boston, MA 02118 (A.J.K., F.W.R., A.M.M., L.E.D., M.D.C., A.G.); Department of Radiology, Friedrich-Alexander University Erlangen-Nürnberg (FAU) and University Hospital Erlangen, Erlangen, Germany (F.W.R.); Department of Radiology, Veterans Affairs Hospital, Boston, Mass (L.E.D., A.G.); and Institute of Sports Imaging, French National Institute of Sports (INSEP), Paris, France (M.D.C.)
| | - Michel D Crema
- From the Department of Radiology, Boston University School of Medicine, 820 Harrison Ave, FGH Building, 3rd Floor, Boston, MA 02118 (A.J.K., F.W.R., A.M.M., L.E.D., M.D.C., A.G.); Department of Radiology, Friedrich-Alexander University Erlangen-Nürnberg (FAU) and University Hospital Erlangen, Erlangen, Germany (F.W.R.); Department of Radiology, Veterans Affairs Hospital, Boston, Mass (L.E.D., A.G.); and Institute of Sports Imaging, French National Institute of Sports (INSEP), Paris, France (M.D.C.)
| | - Ali Guermazi
- From the Department of Radiology, Boston University School of Medicine, 820 Harrison Ave, FGH Building, 3rd Floor, Boston, MA 02118 (A.J.K., F.W.R., A.M.M., L.E.D., M.D.C., A.G.); Department of Radiology, Friedrich-Alexander University Erlangen-Nürnberg (FAU) and University Hospital Erlangen, Erlangen, Germany (F.W.R.); Department of Radiology, Veterans Affairs Hospital, Boston, Mass (L.E.D., A.G.); and Institute of Sports Imaging, French National Institute of Sports (INSEP), Paris, France (M.D.C.)
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Radwan A, Borai A. Neuropathic pain in Egyptian patients with primary knee osteoarthritis: Relationship with functional status and radiological severity. EGYPTIAN RHEUMATOLOGIST 2019. [DOI: 10.1016/j.ejr.2018.12.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Hahm SC, Song E, Jeon H, Yoon YW, Kim J. Transcutaneous Electrical Nerve Stimulation Reduces Knee Osteoarthritic Pain by Inhibiting Spinal Glial Cells in Rats. Phys Ther 2019; 99:1211-1223. [PMID: 31158282 DOI: 10.1093/ptj/pzz076] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2018] [Accepted: 01/09/2019] [Indexed: 12/30/2022]
Abstract
BACKGROUND Transcutaneous electrical nerve stimulation (TENS) is commonly used for pain control. However, the effects of TENS on osteoarthritis (OA) pain and potential underlying mechanisms remain unclear. OBJECTIVE The objective of this study was to investigate the effect of TENS on OA pain treatment and underlying mechanisms related to glial cell inhibition. DESIGN This was an experimental study. METHODS OA was induced by injection of monosodium iodoacetate into the synovial space of the right knee joint of rats. High-frequency (HF) TENS (100 Hz), low-frequency (LF) TENS (4 Hz), or sham TENS was applied to the ipsilateral knee joint for 20 minutes. Paw withdrawal threshold (PWT), weight bearing, and knee bend score (KBS) were measured. Immunohistochemistry for microglia and astrocytes was performed with L3 to L5 spinal segment samples. To investigate the effects of glial inhibition on OA pain, minocycline, l-α-aminoadipate, or artificial cerebrospinal fluid was injected intrathecally, and PWT and KBS were measured. RESULTS Compared with sham TENS, both HF TENS and LF TENS significantly increased PWT, decreased KBS, and inhibited activated microglia in the L3 to L5 segments but did not decrease the total number of microglia, except in the L4 segment (HF TENS). Astrocyte expression was significantly decreased in the L3 to L5 segments following LF TENS and in the L3 segment following HF TENS. Compared with artificial cerebrospinal fluid, both minocycline and l-α-aminoadipate increased PWT and decreased KBS. LIMITATIONS These results cannot be generalized to humans. CONCLUSIONS TENS alleviates OA pain in rats by inhibiting activated microglia and reducing astrocyte expression in the spinal cord. Although these results may not be generalizable to chronic pain in patients with OA, within the limitation of the experimental animal model used in the present study, they suggest a possible mechanism and preclinical evidence supporting further experimentation or clinical use of TENS in humans.
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Affiliation(s)
- Suk-Chan Hahm
- Graduate School of Integrative Medicine, CHA University, Seongnam, Republic of Korea
| | - Eseul Song
- Department of Rehabilitation Standard and Policy, National Rehabilitation Research Institute, National Rehabilitation Center, Seoul, Republic of Korea
| | - Hochung Jeon
- Department of Physical Therapy, College of Health Science, and Department of Public Health Sciences, Korea University, Seoul, Republic of Korea
| | - Young Wook Yoon
- Department of Physiology, College of Medicine, Korea University
| | - Junesun Kim
- Department of Physical Therapy, College of Health Science, Korea University, Anam-dong, Sungbuk-gu, Seoul 136-701, Republic of Korea; and Department of Public Health Sciences, Korea University
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Synovial Cytokines Significantly Correlate with Osteoarthritis-Related Knee Pain and Disability: Inflammatory Mediators of Potential Clinical Relevance. J Clin Med 2019; 8:jcm8091343. [PMID: 31470613 PMCID: PMC6780543 DOI: 10.3390/jcm8091343] [Citation(s) in RCA: 73] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 08/24/2019] [Accepted: 08/26/2019] [Indexed: 12/24/2022] Open
Abstract
The aim of this study was to identify inflammatory mediators of potential clinical relevance in synovial fluid (SF) samples of patients with knee osteoarthritis (OA). Therefore, radiographic OA severity, knee pain and function of 34 OA patients undergoing unicompartmental (UC) and bicompartmental (BC) knee arthroplasty were assessed prior to surgery and SF samples were analyzed for a broad variety of inflammatory mediators, including interleukins (ILs), interferons (IFNs), C-X-C motif ligand chemokines (CXCLs), and growth factors (nerve growth factor; NGF, vascular endothelial growth factor; VEGF, and stem cell growth factor β; SCGF-β) using multiplex assay. Significant differences were observed between the SF levels of different inflammatory markers. When compared to UC OA, significantly higher concentrations of IL-7, IL-8, IL-10, IL-12, IL-13, IFN-γ, VEGF and CXCL1 were detected in BC OA. Correlation analyses revealed significant associations between OA severity and IL-6, IL-8, IFN-γ, SCGF-β, VEGF, CXCL1. Interestingly, increases in both anti- (IL-10, IL-13) and pro-inflammatory (IL-7, IL-12, IFN-γ) cytokines, as well as growth factors (SCGF-β, VEGF), correlated significantly with the level of knee pain. Poorer knee function was associated with higher IL-6, IL-10, IL-12, IL-13, IL-18, βNGF, SCGF-β, VEGF and CXCL9 levels. In conclusion, this study provides an extensive profile of synovial inflammatory mediators in knee OA and identifies cytokines of potential clinical relevance. In fact, five of the mediators examined (IL-10, IL-12, IL-13, SCGF-β, VEGF) significantly correlate with both knee pain and function.
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97
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Nees TA, Rosshirt N, Reiner T, Schiltenwolf M, Moradi B. [Inflammation and osteoarthritis-related pain]. Schmerz 2019; 33:4-12. [PMID: 30560495 DOI: 10.1007/s00482-018-0346-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Osteoarthritis (OA) is one of the major causes of chronic pain. Although OA has long been considered a non-inflammatory "wear and tear" disease leading to loss of articular cartilage, recent findings provide convincing evidence that inflammatory mechanisms play a pivotal role in the pathophysiology of OA. In OA mononuclear cells (e. g. T‑cells and macrophages) infiltrate the synovial membrane and the levels of pro-inflammatory cytokines in peripheral blood and synovial fluid samples are elevated. Increased release of inflammatory mediators including interleukin (IL) IL-1β, IL-6, IL-8, IL-15 und tumor necrosis factor alpha (TNF‑α) induces the expression of proteolytic enzymes such as matrix metalloproteinases resulting in cartilage breakdown. Molecular and cellular interactions between the immune and nervous system are also involved in the development of OA-related pain. Inflammatory mediators including IL-6 und TNF‑α lead to peripheral sensitization of joint nociceptors and growth factors (e. g. NGF) trigger the expression of TRPV1 channels in primary afferents. Moreover, neuropeptides reduce the threshold of nociceptors of OA joints. The current review highlights the role of inflammatory mechanisms in OA-induced joint pain considering clinical signs of inflammation and major inflammatory pathways.
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Affiliation(s)
- T A Nees
- Klinik für Orthopädie und Unfallchirurgie, Zentrum für Orthopädie, Unfallchirurgie und Paraplegiologie, Universitätsklinikum Heidelberg, Schlierbacher Landstraße 200a, 69118, Heidelberg, Deutschland
| | - N Rosshirt
- Klinik für Orthopädie und Unfallchirurgie, Zentrum für Orthopädie, Unfallchirurgie und Paraplegiologie, Universitätsklinikum Heidelberg, Schlierbacher Landstraße 200a, 69118, Heidelberg, Deutschland
| | - T Reiner
- Klinik für Orthopädie und Unfallchirurgie, Zentrum für Orthopädie, Unfallchirurgie und Paraplegiologie, Universitätsklinikum Heidelberg, Schlierbacher Landstraße 200a, 69118, Heidelberg, Deutschland
| | - M Schiltenwolf
- Klinik für Orthopädie und Unfallchirurgie, Zentrum für Orthopädie, Unfallchirurgie und Paraplegiologie, Universitätsklinikum Heidelberg, Schlierbacher Landstraße 200a, 69118, Heidelberg, Deutschland
| | - B Moradi
- Klinik für Orthopädie und Unfallchirurgie, Zentrum für Orthopädie, Unfallchirurgie und Paraplegiologie, Universitätsklinikum Heidelberg, Schlierbacher Landstraße 200a, 69118, Heidelberg, Deutschland.
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98
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Freynhagen R, Parada HA, Calderon-Ospina CA, Chen J, Rakhmawati Emril D, Fernández-Villacorta FJ, Franco H, Ho KY, Lara-Solares A, Li CCF, Mimenza Alvarado A, Nimmaanrat S, Dolma Santos M, Ciampi de Andrade D. Current understanding of the mixed pain concept: a brief narrative review. Curr Med Res Opin 2019; 35:1011-1018. [PMID: 30479161 DOI: 10.1080/03007995.2018.1552042] [Citation(s) in RCA: 93] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Despite having been referenced in the literature for over a decade, the term "mixed pain" has never been formally defined. The strict binary classification of pain as being either purely neuropathic or nociceptive once left a good proportion of patients unclassified; even the recent adoption of "nociplastic pain" in the IASP Terminology leaves out patients who present clinically with a substantial overlap of nociceptive and neuropathic symptoms. For these patients, the term "mixed pain" is increasingly recognized and accepted by clinicians. Thus, an independent group of international multidisciplinary clinicians convened a series of informal discussions to consolidate knowledge and articulate all that is known (or, more accurately, thought to be known) and all that is not known about mixed pain. To inform the group's discussions, a Medline search for the Medical Subject Heading "mixed pain" was performed via PubMed. The search strategy encompassed clinical trial articles and reviews from January 1990 to the present. Clinically relevant articles were selected and reviewed. This paper summarizes the group's consensus on several key aspects of the mixed pain concept, to serve as a foundation for future attempts at generating a mechanistic and/or clinical definition of mixed pain. A definition would have important implications for the development of recommendations or guidelines for diagnosis and treatment of mixed pain.
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Affiliation(s)
- Rainer Freynhagen
- a Department of Anaesthesiology , Critical Care Medicine, Pain Therapy and Palliative Care, Benedictus Hospital Tutzing , Tutzing , Germany
- b Department of Anaesthesiology , Klinikum Rechts der Isar, Technische Universität München , Munich , Germany
| | | | - Carlos Alberto Calderon-Ospina
- d Pharmacology Unit, Department of Biomedical Sciences, School of Medicine and Health Sciences , Universidad del Rosario , Bogota , Colombia
- e Center For Research in Genetics and Genomics (CIGGUR), GENIUROS Research Group, School of Medicine and Health Sciences, Universidad del Rosario , Bogota , Colombia
| | - Juythel Chen
- f Pain Clinic , Hospital Santo Tomas , Panama City , Panama
| | - Dessy Rakhmawati Emril
- g Neurology Department , Medical Faculty of Syiah Kuala University/Dr Zainoel Abidin Hospital (RSUZA) , Banda Aceh , Indonesia
| | | | - Hector Franco
- i Clinica Neurologia y Neurofisiologica Integral , Guatemala City, Guatemala
| | - Kok-Yuen Ho
- j Pain Management Service , Raffles Hospital , Singapore
| | - Argelia Lara-Solares
- k Department of Pain and Palliative Care , Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán , Mexico City , Mexico
| | | | - Alberto Mimenza Alvarado
- m Department of Geriatrics , Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán , Mexico City , Mexico
| | - Sasikaan Nimmaanrat
- n Department of Anesthesiology, Faculty of Medicine , Prince of Songkla University , Hat Yai , Thailand
| | - Maria Dolma Santos
- o Department of Anesthesiology , Asian Hospital and Medical Center , Muntinlupa City , Philippines
- p Department of Anesthesiology , The Medical City , Pasig City , Philippines
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99
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Freo U, Romualdi P, Kress HG. Tapentadol for neuropathic pain: a review of clinical studies. J Pain Res 2019; 12:1537-1551. [PMID: 31190965 PMCID: PMC6529607 DOI: 10.2147/jpr.s190162] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 02/27/2019] [Indexed: 12/13/2022] Open
Abstract
Neuropathic pain (NP) is an enormous burden for patients, caregivers and society. NP is a pain state that may develop after injury of the peripheral or central nervous system because of a wide range of diseases and traumas. A NP symptom component can be found also in several types of chronic pain. Many NP patients are substantially disabled for years. Due to its chronicity, severity and unpredictability, NP is difficult to treat. Tapentadol is a central-acting oral analgesic with combined opioid and noradrenergic properties, which make it potentially suitable for a wide range of pain conditions, particularly whenever a NP component is present or cannot be excluded. In randomized controlled trials, tapentadol has proved to be effective in relieving NP in diabetic peripheral neuropathy and in chronic low back pain. In observational studies, tapentadol reduced NP in chemotherapy-induced peripheral neuropathies, blood and solid cancers, and the NP component in neck pain and Parkinson's disease. This narrative review aims to provide clinicians with a broad overview of tapentadol effects on NP.
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Affiliation(s)
- Ulderico Freo
- Anesthesiology and Intensive Medicine, Department of Medicine DIMED, University of Padua, 35100Padua, Italy
| | - Patrizia Romualdi
- Department of Pharmacy and Biotechnology, Alma Mater Studiorum-University of Bologna, 40126, Bologna, Italy
| | - Hans G Kress
- Department of Special Anaesthesia and Pain Medicine, Medical University/AKH of Vienna, Vienna, Austria
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100
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Rinonapoli G, Coaccioli S, Panella L. Tapentadol in the treatment of osteoarthritis: pharmacological rationale and clinical evidence. J Pain Res 2019; 12:1529-1536. [PMID: 31190964 PMCID: PMC6529616 DOI: 10.2147/jpr.s190161] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 02/27/2019] [Indexed: 01/13/2023] Open
Abstract
Osteoarthritis (OA) is the most prevalent joint disease in older people worldwide. Pain owing to OA is considered one of the most frequent causes of chronic pain; however, current pharmacological approaches have some limitations in terms of efficacy and safety. Of note, descending inhibitory pain pathways are often disrupted in chronic OA pain, and pharmacotherapies targeting those pathways – eg, those that block norepinephrine reuptake may be more appropriate for managing chronic pain than pure μ-opioid receptor (MOR) agonists. Tapentadol is an analgesic molecule, which combines two synergistic mechanisms of action, MOR, and norepinephrine reuptake inhibition. This narrative review will briefly discuss the mechanisms contributing to the onset and maintenance of pain in OA patients; clinical data on the use of tapentadol in this setting will then be presented and commented.
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Affiliation(s)
- Giuseppe Rinonapoli
- Dipartimento di Scienze Chirurgiche, s.c. Ortopedia e Traumatologia Università di Perugia, Ospedale S. Maria della Misericordia, 06100 Perugia, Italy
| | - Stefano Coaccioli
- Department of Medicine, Sezione di Clinica Medica e Anatomia Patologia, Terni, Italy
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