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Abstract
Electric currents can produce quick, reversible control of neural activity. Externally applied electric currents have been used in inhibiting certain ganglion cells in clinical practices. Via electromagnetic induction, a miniature-sized magnetic coil could provide focal stimulation to the ganglion neurons. Here we report that high-frequency stimulation with the miniature coil could reversibly block ganglion cell activity in marine mollusk Aplysia californica, regardless the firing frequency of the neurons, or concentration of potassium ions around the ganglion neurons. Presence of the ganglion sheath has minimal impact on the inhibitory effects of the coil. The inhibitory effect was local to the soma, and was sufficient in blocking the neuron's functional output. Biophysical modeling confirmed that the miniature coil induced a sufficient electric field in the vicinity of the targeted soma. Using a multi-compartment model of Aplysia ganglion neuron, we found that the high-frequency magnetic stimuli altered the ion channel dynamics that were essential for the sustained firing of action potentials in the soma. Results from this study produces several critical insights to further developing the miniature coil technology for neural control by targeting ganglion cells. The miniature coil provides an interesting neural modulation strategy in clinical applications and laboratory research.
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Affiliation(s)
- Hui Ye
- Department of Biology, Quinlan Life Sciences Education and Research Center, Loyola University Chicago, 1032 W. Sheridan Rd., Chicago, IL, 60660, USA.
| | - Lauryn Barrett
- Department of Biology, Quinlan Life Sciences Education and Research Center, Loyola University Chicago, 1032 W. Sheridan Rd., Chicago, IL, 60660, USA
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Murray I, Bhanot G, Bhargava A. Neuron-Glia-Immune Triad and Cortico-Limbic System in Pathology of Pain. Cells 2021; 10:cells10061553. [PMID: 34205372 PMCID: PMC8234386 DOI: 10.3390/cells10061553] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 06/07/2021] [Accepted: 06/15/2021] [Indexed: 01/02/2023] Open
Abstract
Pain is an unpleasant sensation that alerts one to the presence of obnoxious stimuli or sensations. These stimuli are transferred by sensory neurons to the dorsal root ganglia-spinal cord and finally to the brain. Glial cells in the peripheral nervous system, astrocytes in the brain, dorsal root ganglia, and immune cells all contribute to the development, maintenance, and resolution of pain. Both innate and adaptive immune responses modulate pain perception and behavior. Neutrophils, microglial, and T cell activation, essential components of the innate and adaptive immune responses, can play both excitatory and inhibitory roles and are involved in the transition from acute to chronic pain. Immune responses may also exacerbate pain perception by modulating the function of the cortical-limbic brain regions involved in behavioral and emotional responses. The link between an emotional state and pain perception is larger than what is widely acknowledged. In positive psychological states, perception of pain along with other somatic symptoms decreases, whereas in negative psychological states, these symptoms may worsen. Sex differences in mechanisms of pain perception are not well studied. In this review, we highlight what is known, controversies, and the gaps in this field.
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Affiliation(s)
- Isabella Murray
- Department of Obstetrics and Gynecology, Center for Reproductive Sciences, University of California San Francisco, San Francisco, CA 94143, USA; (I.M.); (G.B.)
| | - Gayatri Bhanot
- Department of Obstetrics and Gynecology, Center for Reproductive Sciences, University of California San Francisco, San Francisco, CA 94143, USA; (I.M.); (G.B.)
- Eleanor Roosevelt College, University of California San Diego, San Diego, CA 92122, USA
| | - Aditi Bhargava
- Department of Obstetrics and Gynecology, Center for Reproductive Sciences, University of California San Francisco, San Francisco, CA 94143, USA; (I.M.); (G.B.)
- Correspondence: ; Tel.: +1-415-502-8453
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Quiney L, Stewart J, Routh J, Dyson S. Gross post-mortem and histological features in 27 horses with confirmed lumbosacral region pain and five control horses: A descriptive cadaveric study. Equine Vet J 2021; 54:726-739. [PMID: 34118082 DOI: 10.1111/evj.13488] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Accepted: 05/28/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND There is a lack of understanding of the pathological and/or physiological nature of lumbosacral region pain. OBJECTIVES To describe the gross variations of the osseous and soft tissues of the lumbosacral region and report the histological findings of sections of nerve tissue in affected and control horses. STUDY DESIGN Descriptive post-mortem case series. METHODS All horses had undergone full clinical and gait assessment, including ridden exercise. Horses with a substantial response to infiltration of local anaesthetic solution around the sacroiliac joint regions were included in the affected group (n = 27). Horses for which the source(s) of pain was confirmed by diagnostic anaesthesia to be distant to the lumbosacral region were included in the control group (n = 5). The pelvic regions were isolated and the soft tissues were assessed grossly. Sections of the lumbosacral plexus and cranial gluteal, sciatic and obturator nerves were examined histologically. The osseous specimens were evaluated for anatomical variants and abnormalities. Data were analysed using descriptive statistics. RESULTS Gross discolouration of the sciatic or obturator nerves was observed in 7 (26%) affected and no control horses. Grade 3/3 histological abnormality scores were assigned in 22% of nerve sections from affected horses compared with 3% from control horses. Several osseous variants (bifid sacral spinous processes, straight-shaped sacroiliac joint surface, short arrow-shaped sacral alae, left-right asymmetry of sacral alae, sacral curvature, absence of the fourth to fifth and ankylosis of the fifth to sixth lumbar articular process joints, left-right asymmetry of caudocranial position of the fourth to fifth and lumbar-sacral articular process joints) and abnormalities (sacroiliac enthesopathy, extra ventral sacroiliac joint surface, lumbosacral symphyseal periarticular modelling, lumbosacral intertransverse joint pitting lesions) were more frequently observed in affected horses. MAIN LIMITATIONS Both control and affected horses may have had preclinical abnormalities. CONCLUSIONS Lumbosacral region pain may reflect the presence of a number of pathological changes. Neural pain may play an important role in some horses.
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Affiliation(s)
- Laura Quiney
- Centre for Equine Studies, Animal Health Trust, Newmarket, Suffolk, UK
| | - Jennifer Stewart
- Centre for Preventative Medicine, Animal Health Trust, Newmarket, Suffolk, UK
| | - Jennifer Routh
- Centre for Equine Studies, Animal Health Trust, Newmarket, Suffolk, UK
| | - Sue Dyson
- Centre for Equine Studies, Animal Health Trust, Newmarket, Suffolk, UK
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Char S, Barman RA, Deer TR, Hagedorn JM. Dorsal Root Ganglion Stimulation for Chronic Groin Pain: A Review. Neuromodulation 2021; 25:965-969. [PMID: 34077614 DOI: 10.1111/ner.13468] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 04/19/2021] [Accepted: 05/11/2021] [Indexed: 01/14/2023]
Abstract
INTRODUCTION Chronic neuropathic groin pain develops in a significant number of postsurgical patients; however, multiple etiologies have been identified, and this makes it a challenging condition to treat. While treatment often involves a multimodal approach, advancements in neuromodulation technology, particularly dorsal root ganglion (DRG) stimulation, have benefited patients plagued by chronic pain refractory to standard treatment modalities. Our goal was to provide a definitive source of information for interventional pain physicians regarding groin pain and the use of DRG stimulation for its treatment. MATERIALS AND METHODS In this narrative review, we provide an overview of groin pain and discuss potential pain generators. We also outline appropriate treatment options with particular interest on DRG stimulation. Lastly, we provide a narrative review of the published literature regarding DRG stimulation for chronic groin pain from a variety of etiologies. CONCLUSION DRG stimulation has emerged as an alternative neuromodulatory technique for patients with chronic groin pain. While previous studies suggest substantial sustained pain relief with DRG stimulation in this patient population, prospective randomized controlled studies are necessary before formal recommendations can be made.
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Affiliation(s)
- Steven Char
- Department of Anesthesiology, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Ross A Barman
- Department of Anesthesiology and Perioperative Medicine, Division of Pain Medicine, Mayo Clinic, Rochester, MN, USA
| | - Timothy R Deer
- The Spine and Nerve Centers of the Virginias, Charleston, WV, USA
| | - Jonathan M Hagedorn
- Department of Anesthesiology and Perioperative Medicine, Division of Pain Medicine, Mayo Clinic, Rochester, MN, USA
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Coskun C, Ocal I, Gunay I. A Low-Frequency Pulsed Magnetic Field Reduces Neuropathic Pain by Regulating NaV 1.8 and NaV 1.9 Sodium Channels at the Transcriptional Level in Diabetic Rats. Bioelectromagnetics 2021; 42:357-370. [PMID: 33998011 DOI: 10.1002/bem.22343] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 12/14/2020] [Accepted: 04/09/2021] [Indexed: 12/19/2022]
Abstract
Low-frequency pulsed magnetic field (LF-PMF) application is a non-invasive, easy, and inexpensive treatment method in pain management. However, the molecular mechanism underlying the effect of LF-PMF on pain is not fully understood. Considering the obvious dysregulations of gene expression observed in certain types of voltage-gated sodium channels (VGSCs) in pain conditions, the present study tested the hypothesis that LF-PMF shows its pain-relieving effect by regulating genes that code VGSCs proteins. Five experimental rat groups (Control, Streptozotocin-induced experimental painful diabetic neuropathy (PDN), PDN Sham, PDN 10 Hz PMF, and PDN 30 Hz PMF) were established. After the pain formation in PDN groups, the magnetic field groups were exposed to 10/30 Hz, 1.5 mT PMF for 4 weeks, an hour daily. Progression of pain was evaluated using behavioral pain tests during the entire experimental processes. After the end of PMF treatment, SCN9A (NaV1.7 ), SCN10A (NaV1.8 ), SCN11A (NaV1.9 ), and SCN3A (NaV1.3 ) gene expression level changes were determined by analyzing real-time polymerase chain reaction results. We found that 10 Hz PMF application was more effective than 30 Hz on pain management. In addition, NaV1.7 and NaV1.3 transcriptions were upregulated while NaV1.8 and NaV1.9 were downregulated in painful conditions. Notably, the downregulated expression of the genes encoding NaV1.8 and NaV1.9 were re-regulated and increased to control level by 10 Hz PMF application. Consequently, it may be deduced that 10 Hz PMF application reduces pain by modulating certain VGSCs at the transcriptional level. © 2021 Bioelectromagnetics Society.
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Affiliation(s)
- Cagil Coskun
- Department of Biophysics, Faculty of Medicine, Cukurova University, Adana, Turkey
| | - Isil Ocal
- Department of Biophysics, Faculty of Medicine, Cukurova University, Adana, Turkey
| | - Ismail Gunay
- Department of Biophysics, Faculty of Medicine, Cukurova University, Adana, Turkey
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Ni K, Zhang W, Ni Y, Mao YT, Wang Y, Gu XP, Ma ZL. Dorsal root ganglia NR2B-mediated Epac1-Piezo2 signaling pathway contributes to mechanical allodynia of bone cancer pain. Oncol Lett 2021; 21:338. [PMID: 33692870 DOI: 10.3892/ol.2021.12599] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Accepted: 02/04/2021] [Indexed: 01/14/2023] Open
Abstract
Mechanical allodynia is a painful perception of mechanical stimuli and one of the typical symptoms in bone cancer pain (BCP). Previous studies have revealed that mice and humans lacking mechanically activated Piezo2 channels do not sense mechanical stimuli. However, the underlying mechanism of Piezo2 in BCP has not been well established. The aim of the present study was to investigate whether exchange protein directly activated by cAMP 1 (Epac1) mediated Piezo2 signaling pathway may be responsible for the mechanical allodynia of BCP and whether N-methyl-D-aspartic acid (NMDA) receptor subunit 2B (NR2B) is involved in the pathway. In the present study, a BCP model was established in C3H/HeJ mice by intramedullary injection of osteosarcoma cells. The results of the mechanical allodynia test demonstrated a markedly decreased paw withdrawal mechanical threshold in BCP mice, accompanied by a significant increase in Epac1, NR2B proteins and Piezo2 mRNA expression levels in the ipsilateral dorsal root ganglion (DRG). Compared with the sham group, intrathecal Epac1 antisense oligodeoxynucleotides (Epac1-ASODN) effectively ameliorated the mechanical allodynia and decreased the expression levels of NR2B and Piezo2 in the tumor group. Pretreatment of naïve mice with a NR2B antagonist prevented the aggravation of mechanical allodynia and DRG Piezo2 levels induced by an Epac1 agonist. However, the NR2B agonist-induced increase in Piezo2 expression levels was not reversed by pretreatment with Epac1-ASODN. In conclusion, the results of the present study demonstrated that NR2B, which is a crucial downstream regulator of Epac1, may mediate the Epac1-Piezo2 pathway contributing to the development of the mechanical allodynia of BCP. The present study may enrich the theoretical knowledge of the mechanical allodynia of BCP and provide a potential analgesic strategy for clinical treatment.
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Affiliation(s)
- Kun Ni
- Department of Anesthesiology, Affiliated Drum Tower Hospital of Medical School of Nanjing University, Nanjing, Jiangsu 210008, P.R. China
| | - Wei Zhang
- Department of Anesthesiology, Affiliated Drum Tower Hospital of Medical School of Nanjing University, Nanjing, Jiangsu 210008, P.R. China
| | - Yuan Ni
- Department of Anesthesiology, Affiliated Drum Tower Hospital of Medical School of Nanjing University, Nanjing, Jiangsu 210008, P.R. China
| | - Yan-Ting Mao
- Department of Anesthesiology, Affiliated Drum Tower Hospital of Medical School of Nanjing University, Nanjing, Jiangsu 210008, P.R. China
| | - Yi Wang
- Department of Neurosurgery, Affiliated Drum Tower Hospital of Medical School of Nanjing University, Nanjing, Jiangsu 210008, P.R. China
| | - Xiao-Ping Gu
- Department of Anesthesiology, Affiliated Drum Tower Hospital of Medical School of Nanjing University, Nanjing, Jiangsu 210008, P.R. China
| | - Zheng-Liang Ma
- Department of Anesthesiology, Affiliated Drum Tower Hospital of Medical School of Nanjing University, Nanjing, Jiangsu 210008, P.R. China
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Ferreira N, Gonçalves NP, Jan A, Jensen NM, van der Laan A, Mohseni S, Vægter CB, Jensen PH. Trans-synaptic spreading of alpha-synuclein pathology through sensory afferents leads to sensory nerve degeneration and neuropathic pain. Acta Neuropathol Commun 2021; 9:31. [PMID: 33632316 PMCID: PMC7905893 DOI: 10.1186/s40478-021-01131-8] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 02/11/2021] [Indexed: 01/13/2023] Open
Abstract
Pain is a common non-motor symptom of Parkinson’s disease (PD), with current limited knowledge of its pathophysiology. Here, we show that peripheral inoculation of mouse alpha-synuclein (α-Syn) pre-formed fibrils, in a transgenic mouse model of PD, elicited retrograde trans-synaptic spreading of α-Syn pathology (pSer129) across sensory neurons and dorsal nerve roots, reaching central pain processing regions, including the spinal dorsal horn and the projections of the anterolateral system in the central nervous system (CNS). Pathological peripheral to CNS propagation of α-Syn aggregates along interconnected neuronal populations within sensory afferents, was concomitant with impaired nociceptive response, reflected by mechanical allodynia, reduced nerve conduction velocities (sensory and motor) and degeneration of small- and medium-sized myelinated fibers. Our findings show a link between the transneuronal propagation of α-Syn pathology with sensory neuron dysfunction and neuropathic impairment, suggesting promising avenues of investigation into the mechanisms underlying pain in PD.
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Stelter B, Karri J, Marathe A, Abd-Elsayed A. Dorsal Root Ganglion Stimulation for the Treatment of Non-Complex Regional Pain Syndrome Related Chronic Pain Syndromes: A Systematic Review. Neuromodulation 2021; 24:622-633. [PMID: 33501749 DOI: 10.1111/ner.13361] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 12/08/2020] [Accepted: 12/21/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND While the majority of indications and approvals for dorsal root ganglion stimulation (DRGS) are for the refractory management of complex regional pain syndrome (CRPS), emerging evidence has suggested that DRGS may be favorably used for a plethora of other chronic pain phenomena. Consequently, we aimed to characterize the use and efficacy of DRGS for these non-CRPS-related chronic pain syndromes. MATERIALS AND METHODS A systematic review of clinical studies demonstrating the use of DRGS for non-CRPS-related chronic pain syndromes. The literature search was performed using PubMed, Cochrane Library, and CINAHL plus across August and September 2020. RESULTS A total of 28 reports comprising 354 total patients were included in the analysis. Of the chronic pain syndromes presented, axial low back pain, chronic pelvic and groin pain, other peripheral neuropathies, and studies with multiple concomitant pain syndromes, a majority demonstrated >50% mean pain reduction at the time of last follow-up following DRGS. Physical function, quality of life (QOL), and lesser pain medication usage also were repeatedly reported to be significantly improved. CONCLUSIONS DRGS continues to lack supportive evidence from well designed, high level studies and recommendations from consensus committee experts. However, we present repeated and consistent evidence from lower level studies showing success with the use of DRGS for various non-CRPS chronic pain syndromes in reducing pain along with increasing function and QOL from one week to three years. Due to such low-level, high bias evidence, we strongly encourage the continuation of high-level studies in order to provide a stronger foundation for the use of DRGS in non-CRPS chronic pain patients. However, it may be reasonable and appropriate to evaluate patients for DRGS candidacy on a case-by-case basis particularly if they manifest focal pain syndromes refractory to noninterventional measures and may not be ideal candidates for other forms of neuromodulation.
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Affiliation(s)
- Bradly Stelter
- Department of Anesthesia, Division of Pain Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Jay Karri
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, USA
| | - Anuj Marathe
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, USA
| | - Alaa Abd-Elsayed
- Department of Anesthesia, Division of Pain Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
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Chin ML. Regional Techniques and Interventions for Intractable Neuropathic Pain. Neurology 2021. [DOI: 10.17925/usn.2021.17.1.16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Powell L, Barroso-Gil M, Clowry GJ, Devlin LA, Molinari E, Ramsbottom SA, Miles CG, Sayer JA. Expression patterns of ciliopathy genes ARL3 and CEP120 reveal roles in multisystem development. BMC DEVELOPMENTAL BIOLOGY 2020; 20:26. [PMID: 33297941 PMCID: PMC7727171 DOI: 10.1186/s12861-020-00231-3] [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] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 11/11/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND Joubert syndrome and related disorders (JSRD) and Jeune syndrome are multisystem ciliopathy disorders with overlapping phenotypes. There are a growing number of genetic causes for these rare syndromes, including the recently described genes ARL3 and CEP120. METHODS We sought to explore the developmental expression patterns of ARL3 and CEP120 in humans to gain additional understanding of these genetic conditions. We used an RNA in situ detection technique called RNAscope to characterise ARL3 and CEP120 expression patterns in human embryos and foetuses in collaboration with the MRC-Wellcome Trust Human Developmental Biology Resource. RESULTS Both ARL3 and CEP120 are expressed in early human brain development, including the cerebellum and in the developing retina and kidney, consistent with the clinical phenotypes seen with pathogenic variants in these genes. CONCLUSIONS This study provides insights into the potential pathogenesis of JSRD by uncovering the spatial expression of two JSRD-causative genes during normal human development.
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Affiliation(s)
- L Powell
- Translational and Clinical Research Institute, Newcastle University, Central Parkway, Newcastle upon Tyne, NE1 3BZ, UK
| | - M Barroso-Gil
- Translational and Clinical Research Institute, Newcastle University, Central Parkway, Newcastle upon Tyne, NE1 3BZ, UK
| | - G J Clowry
- Biosciences Institute, Newcastle University, Framlington Place, Newcastle upon Tyne, NE2 4HH, UK
| | - L A Devlin
- Translational and Clinical Research Institute, Newcastle University, Central Parkway, Newcastle upon Tyne, NE1 3BZ, UK
| | - E Molinari
- Translational and Clinical Research Institute, Newcastle University, Central Parkway, Newcastle upon Tyne, NE1 3BZ, UK
| | - S A Ramsbottom
- Translational and Clinical Research Institute, Newcastle University, Central Parkway, Newcastle upon Tyne, NE1 3BZ, UK
| | - C G Miles
- Translational and Clinical Research Institute, Newcastle University, Central Parkway, Newcastle upon Tyne, NE1 3BZ, UK
| | - J A Sayer
- Translational and Clinical Research Institute, Newcastle University, Central Parkway, Newcastle upon Tyne, NE1 3BZ, UK.
- The Newcastle Hospitals NHS Foundation Trust, Freeman Road, Newcastle upon Tyne, NE7 7DN, UK.
- National Institute for Health Research Newcastle Biomedical Research Centre, Newcastle upon Tyne, NE4 5PL, UK.
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Pulsed radiofrequency alleviated neuropathic pain by down-regulating the expression of substance P in chronic constriction injury rat model. Chin Med J (Engl) 2020; 133:190-197. [PMID: 31929370 PMCID: PMC7028183 DOI: 10.1097/cm9.0000000000000619] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background Pulsed radiofrequency (PRF), as a non-invasive treatment of neuropathic pain (NP), has been widely administered clinically. Previous studies have shown that PRF has the potential to improve hyperalgesia in animal models of NP. However, there have been few reports to clarify whether the mechanism of PRF treatment of NP involves intervention in the expression of substance P (SP). Therefore, this study administered PRF treatment to chronic constriction injury (CCI) model rats and observed the sciatic nerve mechanical pain threshold and SP expression in the spinal cord to explore the mechanism of PRF treatment. Methods A total of 96 Sprague-Dawley rats were randomly divided into the sham-surgery-sham-treatment group (S-S group), the sham-surgery-PRF group (S-P group), the CCI-sham-treatment group (C-S group), and the CCI-PRF group (C-P group). The C-S group and the C-P group underwent sciatic nerve CCI, while the other groups received a sham operation. At 14 days after the operation, the C-P group and the S-P group were treated with PRF for 300 s. We recorded the hindpaw withdrawal threshold (HWT) and the thermal withdrawal latency (TWL) of rats in the various groups at baseline, before treatment (0 days), and at 1, 7, 14, and 28 days after treatment. L4 to L6 spinal cord tissues were taken before treatment (0 days) and 1, 7, 14, and 28 days after treatment. The transcription and translation of SP were measured by quantitative polymerase chain reaction and Western blotting, respectively. Results The HWT and the TWL in the C-P group 28 days after PRF treatment were significantly higher than those in the C-S group (95% confidence interval [CI]: 5.84–19.50, P < 0.01; 95% CI: 2.58–8.69, P = 0.01). The expression of SP in the C-P group 28 days after PRF treatment was significantly lower than that in the C-S group (95% CI: 1.17–2.48, P < 0.01). Conclusions PRF may alleviate CCI-induced NP by down-regulating the expression of SP in the spinal cord of CCI model rats.
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Computational analysis of a 9D model for a small DRG neuron. J Comput Neurosci 2020; 48:429-444. [PMID: 32862338 DOI: 10.1007/s10827-020-00761-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 07/20/2020] [Accepted: 08/03/2020] [Indexed: 10/23/2022]
Abstract
Small dorsal root ganglion (DRG) neurons are primary nociceptors which are responsible for sensing pain. Elucidation of their dynamics is essential for understanding and controlling pain. To this end, we present a numerical bifurcation analysis of a small DRG neuron model in this paper. The model is of Hodgkin-Huxley type and has 9 state variables. It consists of a Nav1.7 and a Nav1.8 sodium channel, a leak channel, a delayed rectifier potassium, and an A-type transient potassium channel. The dynamics of this model strongly depend on the maximal conductances of the voltage-gated ion channels and the external current, which can be adjusted experimentally. We show that the neuron dynamics are most sensitive to the Nav1.8 channel maximal conductance ([Formula: see text]). Numerical bifurcation analysis shows that depending on [Formula: see text] and the external current, different parameter regions can be identified with stable steady states, periodic firing of action potentials, mixed-mode oscillations (MMOs), and bistability between stable steady states and stable periodic firing of action potentials. We illustrate and discuss the transitions between these different regimes. We further analyze the behavior of MMOs. As the external current is decreased, we find that MMOs appear after a cyclic limit point. Within this region, bifurcation analysis shows a sequence of isolated periodic solution branches with one large action potential and a number of small amplitude peaks per period. For decreasing external current, the number of small amplitude peaks is increasing and the distance between the large amplitude action potentials is growing, finally tending to infinity and thereby leading to a stable steady state. A closer inspection reveals more complex concatenated MMOs in between these periodic MMO branches, forming Farey sequences. Lastly, we also find small solution windows with aperiodic oscillations which seem to be chaotic. The dynamical patterns found here-as consequences of bifurcation points regulated by different parameters-have potential translational significance as repetitive firing of action potentials imply pain of some form and intensity; manipulating these patterns by regulating the different parameters could aid in investigating pain dynamics.
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Hetta DF, Mohamed AA, Hetta HF, Abd EL‐Hakeem EE, Boshra MM, El‐Barody MM, Fattah Mohammad MA. Radiofrequency Thoracic Sympathectomy for Sympathetically Maintained Chronic Post‐Mastectomy Pain, a Preliminary Report: 6‐Month Results. Pain Pract 2020; 21:54-63. [DOI: 10.1111/papr.12933] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 06/23/2020] [Accepted: 06/28/2020] [Indexed: 01/02/2023]
Affiliation(s)
- Diab Fuad Hetta
- Department of Anesthesia and Pain Management South Egypt Cancer Institute Assuit University Assiut Egypt
| | - Ashraf Amin Mohamed
- Department of Anesthesia and Pain Management South Egypt Cancer Institute Assuit University Assiut Egypt
| | - Helal F. Hetta
- Department of Internal Medicine University of Cincinnati College of Medicine Cincinnati Ohio U.S.A
- Department of Medical Microbiology and Immunology Faculty of Medicine Assiut University AssiutEgypt
| | - Essam Ezzat Abd EL‐Hakeem
- Department of Anesthesia and Intensive Care Assuit University Hospital Assuit University AssiutEgypt
| | - Madona Misheal Boshra
- Department of Anesthesia and Pain Management Department South Egypt, Cancer Institute Assuit University AssiutEgypt
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Campos ACP, Antunes GF, Matsumoto M, Pagano RL, Martinez RCR. Neuroinflammation, Pain and Depression: An Overview of the Main Findings. Front Psychol 2020; 11:1825. [PMID: 32849076 PMCID: PMC7412934 DOI: 10.3389/fpsyg.2020.01825] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 07/02/2020] [Indexed: 12/23/2022] Open
Abstract
Chronic pain is a serious public health problem with a strong affective-motivational component that makes it difficult to treat. Most patients with chronic pain suffer from severe depression; hence, both conditions coexist and exacerbate one another. Brain inflammatory mediators are critical for maintaining depression-pain syndrome and could be substrates for it. The goal of our paper was to review clinical and preclinical findings to identify the neuroinflammatory profile associated with the cooccurrence of pain and depression. In addition, we aimed to explore the regulatory effect of neuronal reorganization on the inflammatory response in pain and depression. We conducted a quantitative review supplemented by manual screening. Our results revealed inflammatory signatures in different preclinical models and clinical articles regarding depression-pain syndrome. We also identified that improvements in depressive symptoms and amelioration of pain can be modulated through direct targeting of inflammatory mediators, such as cytokines and molecular inhibitors of the inflammatory cascade. Additionally, therapeutic targets that improve and regulate the synaptic environment and its neurotransmitters may act as anti-inflammatory compounds, reducing local damage-associated molecular patterns and inhibiting the activation of immune and glial cells. Taken together, our data will help to better elucidate the neuroinflammatory profile in pain and depression and may help to identify pharmacological targets for effective management of depression-pain syndrome.
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Affiliation(s)
| | | | - Marcio Matsumoto
- Anesthesiology Medical Center, Hospital Sirio-Libanes, São Paulo, Brazil
| | | | - Raquel Chacon Ruiz Martinez
- Division of Neuroscience, Hospital Sirio-Libanes, São Paulo, Brazil.,LIM 23, Institute of Psychiatry, University of São Paulo School of Medicine, São Paulo, Brazil
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Kim D, Kim KR, Kwon Y, Kim M, Kim MJ, Sim Y, Ji H, Park JJ, Cho JH, Choi H, Kim S. AAV-Mediated Combination Gene Therapy for Neuropathic Pain: GAD65, GDNF, and IL-10. MOLECULAR THERAPY-METHODS & CLINICAL DEVELOPMENT 2020; 18:473-483. [PMID: 32728596 PMCID: PMC7378317 DOI: 10.1016/j.omtm.2020.06.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 06/22/2020] [Indexed: 12/26/2022]
Abstract
Neuropathic pain is a chronic pain state characterized by nerve damage, inflammation, and nociceptive neuron hyperactivity. As the underlying pathophysiology is complex, a more effective therapy for neuropathic pain would be one that targets multiple elements. Here, we generated recombinant adeno-associated viruses (AAVs) encoding three therapeutic genes, namely, glutamate decarboxylase 65, glial cell-derived neurotrophic factor, and interleukin-10, with various combinations. The efficacy for pain relief was evaluated in a rat spared nerve injury model of neuropathic pain. The maximal analgesic effect was achieved when the AAVs expressing all three genes were administered to rats with neuropathic pain. The combination of two virus constructs expressing the three genes was named KLS-2031 and evaluated as a potential novel therapeutic for neuropathic pain. Single transforaminal epidural injections of KLS-2031 into the intervertebral foramen to target the appropriate dorsal root ganglion produced notable long-term analgesic effects in female and male rats. Furthermore, KLS-2031 mitigated the neuroinflammation, neuronal cell death, and dorsal root ganglion hyperexcitability induced by the spared nerve injury. These results suggest that KLS-2031 represents a promising therapeutic option for refractory neuropathic pain.
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Affiliation(s)
- Daewook Kim
- Institute of BioInnovation Research, Kolon Life Science, 110 Magokdong-ro, Gangseo-gu, Seoul 07793, Republic of Korea
| | - Kyung-Ran Kim
- Institute of BioInnovation Research, Kolon Life Science, 110 Magokdong-ro, Gangseo-gu, Seoul 07793, Republic of Korea
| | - Yejin Kwon
- Institute of BioInnovation Research, Kolon Life Science, 110 Magokdong-ro, Gangseo-gu, Seoul 07793, Republic of Korea
| | - Minjung Kim
- Institute of BioInnovation Research, Kolon Life Science, 110 Magokdong-ro, Gangseo-gu, Seoul 07793, Republic of Korea
| | - Min-Ju Kim
- Institute of BioInnovation Research, Kolon Life Science, 110 Magokdong-ro, Gangseo-gu, Seoul 07793, Republic of Korea
| | - Yeomoon Sim
- Institute of BioInnovation Research, Kolon Life Science, 110 Magokdong-ro, Gangseo-gu, Seoul 07793, Republic of Korea
| | - Hyelin Ji
- Institute of BioInnovation Research, Kolon Life Science, 110 Magokdong-ro, Gangseo-gu, Seoul 07793, Republic of Korea
| | - Jang-Joon Park
- Institute of BioInnovation Research, Kolon Life Science, 110 Magokdong-ro, Gangseo-gu, Seoul 07793, Republic of Korea
| | - Jong-Ho Cho
- Institute of BioInnovation Research, Kolon Life Science, 110 Magokdong-ro, Gangseo-gu, Seoul 07793, Republic of Korea
| | - Heonsik Choi
- Institute of BioInnovation Research, Kolon Life Science, 110 Magokdong-ro, Gangseo-gu, Seoul 07793, Republic of Korea
| | - Sujeong Kim
- Institute of BioInnovation Research, Kolon Life Science, 110 Magokdong-ro, Gangseo-gu, Seoul 07793, Republic of Korea
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Kretzschmar M, Reining M, Schwarz MA. Three-Year Outcomes After Dorsal Root Ganglion Stimulation in the Treatment of Neuropathic Pain After Peripheral Nerve Injury of Upper and Lower Extremities. Neuromodulation 2020; 24:700-707. [PMID: 32573868 DOI: 10.1111/ner.13222] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 04/30/2020] [Accepted: 05/26/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVES Traumatic peripheral nerve injuries (PNI) often result in severe neuropathic pain which typically becomes chronic, is recalcitrant to common analgesics, and is associated with sleep disturbances, anxiety, and depression. Pharmacological treatments proven to be effective against neuropathic pain are not well tolerated due to side effects. Neuromodulative interventions such as peripheral nerve or spinal cord stimulation have generated mixed results and may be limited by reduced somatotopic specificity. Dorsal root ganglion (DRG) stimulation may be more effective in this etiology. MATERIALS AND METHODS Twenty-seven patients were trialed with a DRG neurostimulation system for PNI; trial success (defined as ≥50% pain relief) was 85%, and 23 patients received a permanent stimulator. However, 36-month outcome data was only available for 21 patients. Pain, quality of life, mental and physical function, and opioid usage were assessed at baseline and at 3-, 6-, 12-, 18-, 24-, and 36 months post-permanent implant. Implant-related complications were also documented. RESULTS Compared to baseline, we observed a significant pain relief (p < 0.001) at 3 (58%), 12 (66%), 18 (69%), 24 (71%), and 36 months (73%) in 21 patients (52.5 ± 14.2 years; 12 female), respectively. Mental and physical function showed immediate and sustained improvements. Participants reported improvements in quality of life. Opioid dosage reduced significantly (p < 0.001) at 3 (30%), 12 (93%), 18 (98%), 24 (99%), and 36 months (99%), and 20 of 21 patients were completely opioid-free after 36 months. There were five lead migrations and two electrode fractures (corrected by surgical intervention) and one wound infection (conservatively managed). CONCLUSIONS DRG neuromodulation appears to be a safe, effective, and durable option for treating neuropathic pain caused by PNI. The treatment allows cessation of often ineffective pharmacotherapy (including opioid misuse) and significantly improves quality of life.
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Affiliation(s)
- Michael Kretzschmar
- SRH Wald-Klinikum Gera, Department of Pain Medicine and Palliative Care, Gera, Strasse des Friedens 122, D-07548, Germany.,SRH Hochschule für Gesundheit (University of Applied Health Sciences) Campus Gera, Gera, Neue Strasse 30-32, D-07548, Germany
| | - Marco Reining
- SRH Wald-Klinikum Gera, Department of Pain Medicine and Palliative Care, Gera, Strasse des Friedens 122, D-07548, Germany
| | - Marcus A Schwarz
- SRH Hochschule für Gesundheit (University of Applied Health Sciences) Campus Gera, Gera, Neue Strasse 30-32, D-07548, Germany
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Xie W, Li F, Han Y, Li Z, Xiao J. Neuropeptides are associated with pain threshold and bone microstructure in ovariectomized rats. Neuropeptides 2020; 81:101995. [PMID: 31759680 DOI: 10.1016/j.npep.2019.101995] [Citation(s) in RCA: 8] [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: 09/26/2019] [Revised: 11/04/2019] [Accepted: 11/13/2019] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Postmenopausal osteoporosis (PMO) is a metabolic skeletal disorder with impaired bone density and bone quality in postmenopausal women. The aim of the present study was to investigate the correlation between neuropeptides, bone microstructure and pain threshold in ovariectomized (OVX) rats. METHODS Female rats were randomly divided into the ovariectomized (OVX) group and the sham surgery (SHAM) group. Bone microstructure and immunocytochemistry for substance P (SP), calcitonin gene-related peptide (CGRP), vasoactive intestinal peptide (VIP) and neuropeptide Y (NPY) in tibial and DRG were performed. Pain threshold was assessed at post-operative 11 weeks. Pearson correlation coefficients were calculated between neuropeptides, bone microstructure and pain threshold. RESULTS Significant decreases in bone volume fraction (BV/TV) and trabecular number (Tb. N) but significant increases in trabecular spacing (Tb.Sp) were showed in OVX group. Mechanical pain threshold (MPT) in OVX group was significantly decreased. The MOD values for SP, CGRP and VIP of tibial in OVX group were significantly lower, whereas NPY, NPY1R and NPY2R were significantly higher. And SP, CGRP, VIP, NPY and NPY2R of DRG were significantly increased in OVX group, while NPY1R was significantly decreased. Correlation analysis showed that NPY, Y1R and Y2R in bone were negatively correlated with BV/TV. MPT was negatively correlated with NPY and Y2R in DRG, and positively correlated with Y1R in DRG. CONCLUSIONS Our results suggested that SP, CGRP, VIP and NPY were involved in the osteoporotic bone microstructure and mechanical hypersensitivity in OVX rats, indicating the potential to utilize neuropeptides as novel therapeutic targets for PMO.
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Affiliation(s)
- Weixin Xie
- Department of Orthopaedic Surgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200127, China
| | - Fan Li
- Department of Orthopaedic Surgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200127, China
| | - Yi Han
- Department of Orthopaedic Surgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200127, China
| | - Zhanchun Li
- Department of Orthopaedic Surgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200127, China.
| | - Jie Xiao
- Department of Anesthesiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200127, China.
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Neves AF, Farias FH, de Magalhães SF, Araldi D, Pagliusi M, Tambeli CH, Sartori CR, Lotufo CMDC, Parada CA. Peripheral Inflammatory Hyperalgesia Depends on P2X7 Receptors in Satellite Glial Cells. Front Physiol 2020; 11:473. [PMID: 32523543 PMCID: PMC7261868 DOI: 10.3389/fphys.2020.00473] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 04/17/2020] [Indexed: 12/23/2022] Open
Abstract
Peripheral inflammatory hyperalgesia depends on the sensitization of primary nociceptive neurons. Inflammation drives molecular alterations not only locally but also in the dorsal root ganglion (DRG) where interleukin-1 beta (IL-1β) and purinoceptors are upregulated. Activation of the P2X7 purinoceptors by ATP is essential for IL-1β maturation and release. At the DRG, P2X7R are expressed by satellite glial cells (SGCs) surrounding sensory neurons soma. Although SGCs have no projections outside the sensory ganglia these cells affect pain signaling through intercellular communication. Therefore, here we investigated whether activation of P2X7R by ATP and the subsequent release of IL-1β in DRG participate in peripheral inflammatory hyperalgesia. Immunofluorescent images confirmed the expression of P2X7R and IL-1β in SGCs of the DRG. The function of P2X7R was then verified using a selective antagonist, A-740003, or antisense for P2X7R administered in the L5-DRG. Inflammation was induced by CFA, carrageenan, IL-1β, or PGE2 administered in rat's hind paw. Blockage of P2X7R at the DRG reduced the mechanical hyperalgesia induced by CFA, and prevented the mechanical hyperalgesia induced by carrageenan or IL-1β, but not PGE2. It was also found an increase in P2X7 mRNA expression at the DRG after peripheral inflammation. IL-1β production was also increased by inflammatory stimuli in vivo and in vitro, using SGC-enriched cultures stimulated with LPS. In LPS-stimulated cultures, activation of P2X7R by BzATP induced the release of IL-1β, which was blocked by A-740003. In summary, our data suggest that peripheral inflammation leads to the activation of P2X7R expressed by SGCs at the DRG. Then, ATP-induced activation of P2X7R mediates the release of IL-1β from SGC. This evidence places the SGC as an active player in the establishment of peripheral inflammatory hyperalgesia and highlights the importance of the events in DRG for the treatment of inflammatory diseases.
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Affiliation(s)
- Amanda Ferreira Neves
- Department of Structural and Functional Biology, Institute of Biology, University of Campinas, Campinas, Brazil
| | - Felipe Hertzing Farias
- Department of Structural and Functional Biology, Institute of Biology, University of Campinas, Campinas, Brazil
| | | | - Dionéia Araldi
- Department of Structural and Functional Biology, Institute of Biology, University of Campinas, Campinas, Brazil
| | - Marco Pagliusi
- Department of Structural and Functional Biology, Institute of Biology, University of Campinas, Campinas, Brazil
| | - Claudia Herrera Tambeli
- Department of Structural and Functional Biology, Institute of Biology, University of Campinas, Campinas, Brazil
| | - Cesar Renato Sartori
- Department of Structural and Functional Biology, Institute of Biology, University of Campinas, Campinas, Brazil
| | | | - Carlos Amílcar Parada
- Department of Structural and Functional Biology, Institute of Biology, University of Campinas, Campinas, Brazil
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Madden JF, Davis OC, Boyle KA, Iredale JA, Browne TJ, Callister RJ, Smith DW, Jobling P, Hughes DI, Graham BA. Functional and Molecular Analysis of Proprioceptive Sensory Neuron Excitability in Mice. Front Mol Neurosci 2020; 13:36. [PMID: 32477061 PMCID: PMC7232575 DOI: 10.3389/fnmol.2020.00036] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 02/20/2020] [Indexed: 12/22/2022] Open
Abstract
Neurons located in dorsal root ganglia (DRG) are crucial for transmitting peripheral sensations such as proprioception, touch, temperature, and nociception to the spinal cord before propagating these signals to higher brain structures. To date, difficulty in identifying modality-specific DRG neurons has limited our ability to study specific populations in detail. As the calcium-binding protein parvalbumin (PV) is a neurochemical marker for proprioceptive DRG cells we used a transgenic mouse line expressing green fluorescent protein (GFP) in PV positive DRGs, to study the functional and molecular properties of putative proprioceptive neurons. Immunolabeled DRGs showed a 100% overlap between GFP positive (GFP+) and PV positive cells, confirming the PVeGFP mouse accurately labeled PV neurons. Targeted patch-clamp recording from isolated GFP+ and GFP negative (GFP−) neurons showed the passive membrane properties of the two groups were similar, however, their active properties differed markedly. All GFP+ neurons fired a single spike in response to sustained current injection and their action potentials (APs) had faster rise times, lower thresholds and shorter half widths. A hyperpolarization-activated current (Ih) was observed in all GFP+ neurons but was infrequently noted in the GFP− population (100% vs. 11%). For GFP+ neurons, Ih activation rates varied markedly, suggesting differences in the underlying hyperpolarization-activated cyclic nucleotide-gated channel (HCN) subunit expression responsible for the current kinetics. Furthermore, quantitative polymerase chain reaction (qPCR) showed the HCN subunits 2, 1, and 4 mRNA (in that order) was more abundant in GFP+ neurons, while HCN 3 was more highly expressed in GFP− neurons. Likewise, immunolabeling confirmed HCN 1, 2, and 4 protein expression in GFP+ neurons. In summary, certain functional properties of GFP+ and GFP− cells differ markedly, providing evidence for modality-specific signaling between the two groups. However, the GFP+ DRG population demonstrates considerable internal heterogeneity when hyperpolarization-activated cyclic nucleotide-gated channel (HCN channel) properties and subunit expression are considered. We propose this heterogeneity reflects the existence of different peripheral receptors such as tendon organs, muscle spindles or mechanoreceptors in the putative proprioceptive neuron population.
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Affiliation(s)
- Jessica F Madden
- School of Biomedical Sciences and Pharmacy, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia.,Hunter Medical Research Institute (HMRI), New Lambton Heights, NSW, Australia
| | - Olivia C Davis
- Institute of Neuroscience Psychology, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Kieran A Boyle
- Institute of Neuroscience Psychology, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Jacqueline A Iredale
- School of Biomedical Sciences and Pharmacy, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia.,Hunter Medical Research Institute (HMRI), New Lambton Heights, NSW, Australia
| | - Tyler J Browne
- School of Biomedical Sciences and Pharmacy, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia.,Hunter Medical Research Institute (HMRI), New Lambton Heights, NSW, Australia
| | - Robert J Callister
- School of Biomedical Sciences and Pharmacy, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia.,Hunter Medical Research Institute (HMRI), New Lambton Heights, NSW, Australia
| | - Douglas W Smith
- School of Biomedical Sciences and Pharmacy, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia.,Hunter Medical Research Institute (HMRI), New Lambton Heights, NSW, Australia
| | - Phillip Jobling
- School of Biomedical Sciences and Pharmacy, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia.,Hunter Medical Research Institute (HMRI), New Lambton Heights, NSW, Australia
| | - David I Hughes
- Institute of Neuroscience Psychology, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Brett A Graham
- School of Biomedical Sciences and Pharmacy, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia.,Hunter Medical Research Institute (HMRI), New Lambton Heights, NSW, Australia
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Chapman KB, Groenen PS, Vissers KC, van Helmond N, Stanton-Hicks MD. The Pathways and Processes Underlying Spinal Transmission of Low Back Pain: Observations From Dorsal Root Ganglion Stimulation Treatment. Neuromodulation 2020; 24:610-621. [PMID: 32329155 DOI: 10.1111/ner.13150] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 03/02/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Dorsal root ganglion stimulation (DRG-S) is a novel approach to treat chronic pain. Lead placement at L2 has been reported to be an effective treatment for axial low back pain (LBP) primarily of discogenic etiology. We have recently shown, in a diverse cohort including cases of multilevel instrumentation following extensive prior back surgeries, that DRG-S lead placement at T12 is another promising target. Local effects at the T12 DRG, alone, are insufficient to explain these results. MATERIALS AND METHODS We performed a literature review to explore the mechanisms of LBP relief with T12 DRG-S. FINDINGS Branches of individual spinal nerve roots innervate facet joints and posterior spinal structures, while the discs and anterior vertebrae are carried via L2, and converge in the dorsal horn (DH) of the spinal cord at T8-T9. The T12 nerve root contains cutaneous afferents from the low back and enters the DH of the spinal cord at T10. Low back Aδ and C-fibers then ascend via Lissauer's tract (LT) to T8-T9, converging with other low back afferents. DRG-S at T12, then, results in inhibition of the converged low back fibers via endorphin-mediated and GABAergic frequency-dependent mechanisms. Therefore, T12 lead placement may be the optimal location for DRG-S to treat LBP.
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Affiliation(s)
- Kenneth B Chapman
- The Spine & Pain Institute of New York, New York City, NY, USA.,Department of Anesthesiology, New York University Langone Medical Center, New York City, NY, USA.,Northwell Health Systems, New York City, NY, USA
| | - Pauline S Groenen
- The Spine & Pain Institute of New York, New York City, NY, USA.,College of Medicine, Radboud University, Nijmegen, the Netherlands
| | - Kris C Vissers
- Department of Anesthesiology, Pain, and Palliative Medicine, Radboud University, Nijmegen, the Netherlands
| | - Noud van Helmond
- The Spine & Pain Institute of New York, New York City, NY, USA.,Department of Anesthesiology, Cooper Medical School of Rowan University, Cooper University Hospital, Camden, NJ, USA
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71
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Esposito MF, Malayil R, Hanes M, Deer T. Unique Characteristics of the Dorsal Root Ganglion as a Target for Neuromodulation. PAIN MEDICINE 2020; 20:S23-S30. [PMID: 31152179 PMCID: PMC6544557 DOI: 10.1093/pm/pnz012] [Citation(s) in RCA: 114] [Impact Index Per Article: 28.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Objective The dorsal root ganglion (DRG) is a novel target for neuromodulation, and DRG stimulation is proving to be a viable option in the treatment of chronic intractable neuropathic pain. Although the overall principle of conventional spinal cord stimulation (SCS) and DRG stimulation—in which an electric field is applied to a neural target with the intent of affecting neural pathways to decrease pain perception—is similar, there are significant differences in the anatomy and physiology of the DRG that make it an ideal target for neuromodulation and may account for the superior outcomes observed in the treatment of certain chronic neuropathic pain states. This review highlights the anatomy of the DRG, its function in maintaining homeostasis and its role in neuropathic pain, and the unique value of DRG as a target in neuromodulation for pain. Methods A narrative literature review was performed. Results Overall, the DRG is a critical structure in sensory transduction and modulation, including pain transmission and the maintenance of persistent neuropathic pain states. Unique characteristics including selective somatic organization, specialized membrane characteristics, and accessible and consistent location make the DRG an ideal target for neuromodulation. Because DRG stimulation directly recruits the somata of primary sensory neurons and harnesses the filtering capacity of the pseudounipolar neural architecture, it is differentiated from SCS, peripheral nerve stimulation, and other neuromodulation options. Conclusions There are several advantages to targeting the DRG, including lower energy usage, more focused and posture-independent stimulation, reduced paresthesia, and improved clinical outcomes.
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Affiliation(s)
| | - Rudy Malayil
- St. Mary's Pain Relief Specialists, Huntington, West Virginia
| | | | - Timothy Deer
- The Spine and Nerve Center of the Virginias, Charleston, West Virginia, USA
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Abd-Elsayed A, Abdallah R, Falowski S, Chaiban G, Burkey A, Slavin K, Guirguis M, Raslan AM. Development of an Educational Curriculum for Spinal Cord Stimulation. Neuromodulation 2020; 23:555-561. [PMID: 32282109 DOI: 10.1111/ner.13142] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Revised: 01/30/2020] [Accepted: 02/18/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Spinal cord stimulators (SCSs) are used for treating chronic pain. The number of SCSs implanted each year is on the increase. The North American Neuromodulation Society (NANS) education committee aimed to develop a SCS curriculum as a tool to guide physicians at different training levels, based on the most recent evidence. MATERIAL AND METHODS A multidisciplinary (anesthesiology, physical medicine, neurosurgery, and neurology), taskforce representing the education committee of the NANS met to develop a SCS curriculum following the Accreditation Council for Graduate Medical Education (ACGME) milestones. The task force used the best available evidence and knowledge to develop the curriculum. Once developed, the SCS curriculum was then approved by the NANS board. RESULTS The task force developed a SCS training curriculum. Milestones included patient care and procedural skills, system-based practice, medical knowledge, interpersonal communication, practice based learning and professionalism. Each milestone was defined for three categories, early learner, advanced learner, and practitioner. CONCLUSION A multidisciplinary task force of the NANS education committee developed a SCS training curriculum that defines ACGME milestones for basic learners, advanced learners, and practitioners.
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Affiliation(s)
- Alaa Abd-Elsayed
- Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Rany Abdallah
- Department of Anesthesiology, Temple University, Philadelphia, PA, USA
| | | | - Gassan Chaiban
- Department of Anesthesiology, the Ochsner Medical Center, New Orleans, LA, USA
| | - Adam Burkey
- Department of Anesthesia, University of Pennsylvania Health System, Philadelphia, PA, USA
| | - Konstantin Slavin
- Department of Neurosurgery, University of Illinois Hospital, Chicago, IL, USA
| | - Maged Guirguis
- Department of Anesthesiology, the Ochsner Medical Center, New Orleans, LA, USA
| | - Ahmed M Raslan
- Department of Neurological Surgery, Oregon Health & Science University, Portland, OR, USA
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73
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Ma J, Stefanoska D, Grad S, Alini M, Peroglio M. Direct and Intervertebral Disc-Mediated Sensitization of Dorsal Root Ganglion Neurons by Hypoxia and Low pH. Neurospine 2020; 17:42-59. [PMID: 32252154 PMCID: PMC7136118 DOI: 10.14245/ns.2040052.026] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 02/28/2020] [Indexed: 12/21/2022] Open
Abstract
Objective Ischemia-related risk factors are consistently correlated with discogenic pain, but it remains unclear how the ischemia-associated hypoxia and acidosis influence the peripheral sensory nervous system, namely the dorsal root ganglion (DRG), either directly or indirectly via intervertebral disc (IVD) mediation.
Methods Bovine tail IVD organ cultures were preconditioned in different hypoxic and/or acidic conditions for 3 days to collect the conditioned medium (CM). The DRG-derived ND7/23 cells were either treated by the IVD CM or directly stimulated by hypoxic and/or acidic conditions. Neuronal sensitization was evaluated using calcium imaging (Fluo-4) after 3 days.
Results We found that direct exposure of DRG cell line to hypoxia and acidosis increased both spontaneous and bradykinin-stimulated calcium response compared to normoxia-neutral pH cultures. Hypoxia and low pH in combination showed stronger effect than either parameter on its own. Indirect exposure of DRG to hypoxia-acidosis-stressed IVD CM also increased spontaneous and bradykinin-stimulated response, but to a lower extent than direct exposure. The impact of direct hypoxia and acidosis on DRG was validated in a primary sheep DRG cell culture, showing the same trend.
Conclusion Our data suggest that targeting hypoxia and acidosis stresses both in IVD and DRG could be a relevant objective in discogenic pain treatment.
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Affiliation(s)
- Junxuan Ma
- AO Research Institute Davos, Davos, Switzerland
| | | | | | - Mauro Alini
- AO Research Institute Davos, Davos, Switzerland
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Atmaramani R, Pancrazio JJ, Black BJ. Adaptation of robust Z' factor for assay quality assessment in microelectrode array based screening using adult dorsal root ganglion neurons. J Neurosci Methods 2020; 339:108699. [PMID: 32224158 DOI: 10.1016/j.jneumeth.2020.108699] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 03/04/2020] [Accepted: 03/23/2020] [Indexed: 01/02/2023]
Abstract
BACKGROUND Cell-based assays comprising primary sensory neurons cultured in vitro are an emerging tool for the screening and identification of potential analgesic compounds and chronic pain treatments. High-content screening (HCS) platforms for drug screening are characterized by a measure of assay quality indicator, such as the Z'-factor, which considers the signal dynamic range and data variation using control compounds only. Although widely accepted as a quality metric in high throughput screening (HTS), standard Z'-factor are not well-suited to indicate the quality of complex cell-based assays. NEW METHOD The present study describes a method to assess assay quality in the context of extracellular recordings from dorsal root ganglion (DRG) sensory neurons cultured on multi-well microelectrode arrays. Data transformations are applied to electrophysiological parameters, such as electrode and well spike rates, for valid normality assumptions and suitability for use as a sample signal. Importantly, using transformed well-wide metrics, a robust version of the Z'-factor was applied, based on the median and median absolute deviation, to indicate assay quality and assess hit identification of putative pharmacological compounds. RESULTS Application of appropriately scaled data and robust statistics ensured insensitivity to data variation and approximation of normal distribution. The use median and median absolute deviation of log transformed well spike rates in computing the Z'-factor revealed a value of 0.61, which is accepted as an "excellent assay." Known antagonists of nociceptor-specific voltage-gated sodium ion channels were identified as true hits in the present assay format under both spontaneous and thermally stimulated conditions. COMPARISON WITH EXISTING METHODS The present approach demonstrated a large signal dynamic range and reduced sensitivity to data variation compared to standard Z'-factor used widely in HTS. CONCLUSION Overall, the present study provides a statistical basis for the implementation of a HCS platform utilizing adult DRG neurons on microelectrode arrays.
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Affiliation(s)
- Rahul Atmaramani
- Department of Bioengineering, University of Texas at Dallas, Richardson, TX 75080, USA; Center for Advanced Pain Studies, University of Texas at Dallas, Richardson, TX 75080, USA
| | - Joseph J Pancrazio
- Department of Bioengineering, University of Texas at Dallas, Richardson, TX 75080, USA; Center for Advanced Pain Studies, University of Texas at Dallas, Richardson, TX 75080, USA
| | - Bryan J Black
- Department of Bioengineering, University of Texas at Dallas, Richardson, TX 75080, USA; Center for Advanced Pain Studies, University of Texas at Dallas, Richardson, TX 75080, USA.
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75
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Levy RM, Mekhail N, Kramer J, Poree L, Amirdelfan K, Grigsby E, Staats P, Burton AW, Burgher AH, Scowcroft J, Golovac S, Kapural L, Paicius R, Pope J, Samuel S, McRoberts WP, Schaufele M, Kent AR, Raza A, Deer TR. Therapy Habituation at 12 Months: Spinal Cord Stimulation Versus Dorsal Root Ganglion Stimulation for Complex Regional Pain Syndrome Type I and II. THE JOURNAL OF PAIN 2020; 21:399-408. [DOI: 10.1016/j.jpain.2019.08.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 05/03/2019] [Accepted: 08/27/2019] [Indexed: 12/19/2022]
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76
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Behavioral, Electrophysiological, and Histological Characterization of a New Rat Model for Neoadjuvant Chemotherapy–Induced Neuropathic Pain: Therapeutic Potential of Duloxetine and Allopregnanolone Concomitant Treatment. Neurotox Res 2020; 38:145-162. [DOI: 10.1007/s12640-020-00176-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 01/12/2020] [Accepted: 02/06/2020] [Indexed: 12/13/2022]
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77
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Yeh CH, Caswell K, Pandiri S, Sair H, Lukkahatai N, Campbell CM, Stearns V, Van de Castle B, Perrin N, Smith TJ, Saligan LN. Dynamic Brain Activity Following Auricular Point Acupressure in Chemotherapy-Induced Neuropathy: A Pilot Longitudinal Functional Magnetic Resonance Imaging Study. Glob Adv Health Med 2020; 9:2164956120906092. [PMID: 32110475 PMCID: PMC7019394 DOI: 10.1177/2164956120906092] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 01/20/2020] [Indexed: 01/25/2023] Open
Abstract
Background The objective of this study was to investigate the dynamic brain activity
following auricular point acupressure (APA) in chemotherapy-induced
neuropathy (CIN). Methods Participants received 4 weeks of APA in an open-pilot trial with repeated
observation. Along with the clinical self-reported CIN outcomes, objective
outcomes were measured over the course of the treatment by physiological
changes in pain sensory thresholds from quantitative sensory testing (QST)
and repeated functional magnetic resonance imaging scans. Results After 4 weeks of APA, participants had reported clinically significant
improvements (ie, ≥30%) in a reduction of CIN symptoms (including pain,
numbness, tingling, and stiffness) in lower extremity stiffness (32%),
reduced foot sensitivity (13%), and higher pain threshold (13%). Across the
11 intrinsic brain networks examined, there was a trend toward significance
of the connectivity of the basal ganglia network (BGN) to the salience
network (SAL), which was decreased pre-APA versus immediate-APA (effect size
[ES] = 1.04, P = .07). The BGN also demonstrated decreased
connectivity with the language network pre-APA versus delayed imaging
post-APA (ES = −0.92, P = .07). Furthermore, there was
increased executive control network (ECN) and SAL within-network
connectivity comparing pre-APA to delayed imaging post-APA, trending toward
significance (ES = 0.41, P = .09 and ES = 0.17,
P = .09, respectively). Conclusion The changes in connectivity and activity within or between the ECN, SAL, and
BGN from pre- to post-APA suggest ongoing alterations in brain functional
connectivity following APA, particularly in the insula, anterior cingulate,
and dorsolateral prefrontal cortices, which play significant roles in pain,
memory, and cognitive function.
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Affiliation(s)
- Chao Hsing Yeh
- Johns Hopkins University School of Nursing, Baltimore, Maryland
| | - Keenan Caswell
- Johns Hopkins University School of Nursing, Baltimore, Maryland
| | - Sonaali Pandiri
- Johns Hopkins University School of Nursing, Baltimore, Maryland
| | - Haris Sair
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Nada Lukkahatai
- Johns Hopkins University School of Nursing, Baltimore, Maryland
| | - Claudia M Campbell
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Vered Stearns
- Breast and Ovarian Cancer Program, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Barbara Van de Castle
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Nancy Perrin
- Johns Hopkins University School of Nursing, Baltimore, Maryland
| | - Thomas J Smith
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Leorey N Saligan
- National Institute of Nursing Research, National Institutes of Health, Bethesda, Maryland
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78
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Islam J, Kc E, Oh BH, Moon HC, Park YS. Pain modulation effect on motor cortex after optogenetic stimulation in shPKCγ knockdown dorsal root ganglion-compressed Sprague-Dawley rat model. Mol Pain 2020; 16:1744806920943685. [PMID: 32865105 PMCID: PMC7466896 DOI: 10.1177/1744806920943685] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 06/03/2020] [Accepted: 06/08/2020] [Indexed: 12/14/2022] Open
Abstract
Neuropathic pain can be generated by chronic compression of dorsal root ganglion (CCD). Stimulation of primary motor cortex can disrupt the nociceptive sensory signal at dorsal root ganglion level and reduce pain behaviors. But the mechanism behind it is still implicit. Protein kinase C gamma is known as an essential enzyme for the development of neuropathic pain, and specific inhibitor of protein kinase C gamma can disrupt the sensory signal and reduce pain behaviors. Optogenetic stimulation has been emerged as a new and promising conducive method for refractory neuropathic pain. The aim of this study was to provide evidence whether optical stimulation of primary motor cortex can modulate chronic neuropathic pain in CCD rat model. Animals were randomly divided into CCD group, sham group, and control group. Dorsal root ganglion-compressed neuropathic pain model was established in animals, and knocking down of protein kinase C gamma was also accomplished. Pain behavioral scores were significantly improved in the short hairpin Protein Kinase C gamma knockdown CCD animals during optic stimulation. Ventral posterolateral thalamic firing inhibition was also observed during light stimulation on motor cortex in CCD animal. We assessed alteration of pain behaviors in pre-light off, stimulation-light on, and post-light off state. In vivo extracellular recording of the ventral posterolateral thalamus, viral expression in the primary motor cortex, and protein kinase C gamma expression in dorsal root ganglion were investigated. So, optical cortico-thalamic inhibition by motor cortex stimulation can improve neuropathic pain behaviors in CCD animal, and knocking down of protein kinase C gamma plays a conducive role in the process. This study provides feasibility for in vivo optogenetic stimulation on primary motor cortex of dorsal root ganglion-initiated neuropathic pain.
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Affiliation(s)
- Jaisan Islam
- Department of Neuroscience, College of Medicine, Chungbuk National University, Republic of Korea
| | - Elina Kc
- Department of Neuroscience, College of Medicine, Chungbuk National University, Republic of Korea
| | - Byeong Ho Oh
- Department of Neurosurgery, College of Medicine, Chungbuk National University, Chungbuk National University Hospital, Republic of Korea
| | - Hyeong Cheol Moon
- Department of Neuroscience, College of Medicine, Chungbuk National University, Republic of Korea
- Department of Neurosurgery, Gamma Knife Icon Center, Chungbuk National University Hospital, Republic of Korea
| | - Young Seok Park
- Department of Neuroscience, College of Medicine, Chungbuk National University, Republic of Korea
- Department of Neurosurgery, College of Medicine, Chungbuk National University, Chungbuk National University Hospital, Republic of Korea
- Department of Neurosurgery, Gamma Knife Icon Center, Chungbuk National University Hospital, Republic of Korea
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79
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Haight ES, Forman TE, Cordonnier SA, James ML, Tawfik VL. Microglial Modulation as a Target for Chronic Pain: From the Bench to the Bedside and Back. Anesth Analg 2019; 128:737-746. [PMID: 30883419 DOI: 10.1213/ane.0000000000004033] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
With a widespread opioid epidemic and profound biopsychosocial implications, chronic pain is a multifaceted public health issue requiring urgent attention. The treatment of chronic pain is particularly important to anesthesiologists given our unique role as perioperative physicians and pain medicine specialists. The present review details the recent shift from a neuronal theory of chronic pain to one that includes complex neuron-glia interactions. In particular, we highlight microglia, the myeloid-lineage cells of the central nervous system, as initiators of a postinjury neuroimmune response that contributes to the acute to chronic pain transition. We discuss ever-advancing preclinical studies, wherein significant success has been made through pharmacologic and genetic modulation of microglia, and we emphasize where these approaches have made the transition to the clinical realm. Furthermore, we highlight the most current, novel efforts to visualize glial activation in vivo using positron emission tomography and improve the diagnosis of chronic pain through radiotracer binding of specific targets, like the 18 kDa translocator protein in microglia and myeloid-lineage cells. Our rapidly advancing knowledge about microglia and their involvement in pain suggests that the era of glial-targeted therapeutics is just beginning so long as we refocus our attention on optimizing preclinical studies using a clinically informed approach, before translation.
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Affiliation(s)
- Elena S Haight
- From the Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, California
| | - Thomas E Forman
- From the Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, California.,University of Colorado School of Medicine, Denver, Colorado
| | - Stephanie A Cordonnier
- From the Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, California.,College of Medicine and Life Sciences, University of Toledo, Toledo, Ohio
| | - Michelle L James
- Departments of Radiology and Neurology, Stanford University School of Medicine, Stanford, California
| | - Vivianne L Tawfik
- From the Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, California
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80
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Yasko JR, Moss IL, Mains RE. Transcriptional Profiling of Non-injured Nociceptors After Spinal Cord Injury Reveals Diverse Molecular Changes. Front Mol Neurosci 2019; 12:284. [PMID: 32038157 PMCID: PMC6988781 DOI: 10.3389/fnmol.2019.00284] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 11/08/2019] [Indexed: 01/01/2023] Open
Abstract
Traumatic spinal cord injury (SCI) has devastating implications for patients, including a high predisposition for developing chronic pain distal to the site of injury. Chronic pain develops weeks to months after injury, consequently, patients are treated after irreparable changes have occurred. Nociceptors are central to chronic pain; however, the diversity of this cellular population presents challenges to understanding mechanisms and attributing pain modalities to specific cell types. To begin to address how peripheral sensory neurons below the injury level may contribute to the below-level pain reported by SCI patients, we examined SCI-induced changes in gene expression in lumbar dorsal root ganglia (DRG) below the site of injury. SCI was performed at the T10 vertebral level, with injury produced by a vessel clip with a closing pressure of 15 g for 1 min. Alterations in gene expression produce long-term sensory changes, therefore, we were interested in studying SCI-induced transcripts before the onset of chronic pain, which may trigger changes in downstream signaling pathways and ultimately facilitate the transmission of pain. To examine changes in the nociceptor subpopulation in DRG distal to the site of injury, we retrograde labeled sensory neurons projecting to the hairy hindpaw skin with fluorescent dye and collected the corresponding lumbar (L2–L6) DRG 4 days post-injury. Following dissociation, labeled neurons were purified by fluorescence-activated cell sorting (FACS). RNA was extracted from sorted sensory neurons of naïve, sham, or SCI mice and sequenced. Transcript abundances validated that the desired population of nociceptors were isolated. Cross-comparisons to data sets from similar studies confirmed, we were able to isolate our cells of interest and identify a unique pattern of gene expression within a subpopulation of neurons projecting to the hairy hindpaw skin. Differential gene expression analysis showed high expression levels and significant transcript changes 4 days post-injury in SCI cell populations relevant to the onset of chronic pain. Regulatory interrelationships predicted by pathway analysis implicated changes within the synaptogenesis signaling pathway as well as networks related to inflammatory signaling mechanisms, suggesting a role for synaptic plasticity and a correlation with pro-inflammatory signaling in the transition from acute to chronic pain.
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Affiliation(s)
- Jessica R Yasko
- Department of Neuroscience, University of Connecticut Health Center, Farmington, CT, United States
| | - Isaac L Moss
- Department of Orthopedic Surgery and the Comprehensive Spine Center, University of Connecticut Health Center, Farmington, CT, United States
| | - Richard E Mains
- Department of Neuroscience, University of Connecticut Health Center, Farmington, CT, United States
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81
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A Role for The P2Y1 Receptor in Nonsynaptic Cross-depolarization in the Rat Dorsal Root Ganglia. Neuroscience 2019; 423:98-108. [PMID: 31689490 DOI: 10.1016/j.neuroscience.2019.09.038] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 09/19/2019] [Accepted: 09/27/2019] [Indexed: 12/19/2022]
Abstract
Non-synaptic transmission is pervasive throughout the nervous system. It appears especially prevalent in peripheral ganglia, where non-synaptic interactions between neighboring cell bodies have been described in both physiological and pathological conditions, a phenomenon referred to as cross-depolarization (CD) and thought to play a role in sensory processing and chronic pain. CD has been proposed to be mediated by a chemical agent, but its identity has remained elusive. Here, we report that in the rat dorsal root ganglion (DRG), the P2Y1 purinergic receptor (P2RY1) plays an important role in regulating CD. The effect of P2RY1 is cell-type specific: pharmacological blockade of P2RY1 inhibited CD in A-type neurons while enhancing it in C-type neurons. In the nodose ganglion of the vagus, CD requires extracellular calcium in a large percentage of cells. In contrast, we show that in the DRG extracellular calcium appears to play no major role, pointing to a mechanistic difference between the two peripheral ganglia. Furthermore, we show that DRG glial cells also play a cell-type specific role in CD regulation. Fluorocitrate-induced glial inactivation had no effect on A-cells but enhanced CD in C-cells. These findings shed light on the mechanism of CD in the DRG and pave the way for further analysis of non-synaptic neuronal communication in sensory ganglia.
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82
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Laval K, Van Cleemput J, Vernejoul JB, Enquist LW. Alphaherpesvirus infection of mice primes PNS neurons to an inflammatory state regulated by TLR2 and type I IFN signaling. PLoS Pathog 2019; 15:e1008087. [PMID: 31675371 PMCID: PMC6824567 DOI: 10.1371/journal.ppat.1008087] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 09/17/2019] [Indexed: 12/31/2022] Open
Abstract
Pseudorabies virus (PRV), an alphaherpesvirus closely related to Varicella-Zoster virus (VZV) and Herpes simplex type 1 (HSV1) infects mucosa epithelia and the peripheral nervous system (PNS) of its host. We previously demonstrated that PRV infection induces a specific and lethal inflammatory response, contributing to severe neuropathy in mice. So far, the mechanisms that initiate this neuroinflammation remain unknown. Using a mouse footpad inoculation model, we found that PRV infection rapidly and simultaneously induces high G-CSF and IL-6 levels in several mouse tissues, including the footpad, PNS and central nervous system (CNS) tissues. Interestingly, this global increase occurred before PRV had replicated in dorsal root ganglia (DRGs) neurons and also was independent of systemic inflammation. These high G-CSF and IL-6 levels were not caused by neutrophil infiltration in PRV infected tissues, as we did not detect any neutrophils. Efficient PRV replication and spread in the footpad was sufficient to activate DRGs to produce cytokines. Finally, by using knockout mice, we demonstrated that TLR2 and IFN type I play crucial roles in modulating the early neuroinflammatory response and clinical outcome of PRV infection in mice. Overall, these results give new insights into the initiation of virus-induced neuroinflammation during herpesvirus infections. Herpesviruses are major pathogens worldwide. Pseudorabies virus (PRV) is an alphaherpesvirus related to varicella-zoster virus (VZV) and herpes simplex virus type 1 (HSV1). The natural host is the pig, but PRV can infect most mammals. In these non-natural hosts, the virus causes a severe pruritus called the ‘mad itch’. Interestingly, PRV infects the peripheral nervous system (PNS) and induces a specific and lethal inflammatory response in mice, yet little is know about how this neuroinflammatory response is initiated. In this study, we demonstrated for the first time how PNS neurons tightly regulate the inflammatory response during PRV infection and contribute to severe clinical outcome in mice. Our work provides new insights into the process of alphaherpesvirus-induced neuropathies, leading to the development of innovative therapeutic strategies.
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Affiliation(s)
- Kathlyn Laval
- Department of Molecular Biology, Princeton University, Princeton, New Jersey, United States of America
- * E-mail:
| | - Jolien Van Cleemput
- Department of Molecular Biology, Princeton University, Princeton, New Jersey, United States of America
| | - Jonah B. Vernejoul
- Department of Molecular Biology, Princeton University, Princeton, New Jersey, United States of America
| | - Lynn W. Enquist
- Department of Molecular Biology, Princeton University, Princeton, New Jersey, United States of America
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83
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Chapman KB, Groenen PS, Patel KV, Vissers KC, van Helmond N. T12 Dorsal Root Ganglion Stimulation to Treat Chronic Low Back Pain: A Case Series. Neuromodulation 2019; 23:203-212. [PMID: 31588662 DOI: 10.1111/ner.13047] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 07/13/2019] [Accepted: 08/19/2019] [Indexed: 01/17/2023]
Abstract
INTRODUCTION Dorsal root ganglion stimulation (DRG-S) is a neuromodulation technique for treating neuropathic pain syndromes. Research has demonstrated DRG-S to be more effective than conventional SCS in treating RSD/CRPS, particularly of the lower extremities. Results from recent case series and prospective studies suggest that DRG-S may be effective in treatment of pain syndromes considered to have non-neuropathic components and characteristics (e.g. nociceptive). There have been multiple, small studies demonstrating efficacy of DRG-S for axial low back pain. There has, however, been no consensus regarding the best location for DRG lead placement in the treatment of low back pain. METHODS Patients presenting with refractory low back pain in a private pain management practice were considered for DRG-S. Patients were provided a trial stimulator prior to potential implantation. Per standard practice, pain intensity, disability, general health status, and quality of life were followed using the visual analog scale (VAS), Oswestry Disability Index, EQ-5D index, and the SF-36 survey, respectively. Data were collected prior to implantation and at variable follow-ups after DRG-S initiation. RESULTS Seventeen consecutive patients presented with predominantly axial low back pain with/without a secondary component of lower extremity pain. All were trialed and subsequently implanted for DRG-S. Leads were placed at T12 to target the low back. Stimulation levels were set very low, below that of which patients experienced paresthesias. Last follow-up times averaged 8.3 months. More than half of the patients experienced pain relief ≥80%, with an average low back pain relief of 78% at last follow-up. Additionally, substantial improvements in physical and mental functioning, disability, and quality of life were reported. CONCLUSIONS T12 DRG-S can be an effective treatment for chronic axial low back pain. Stimulation results in reduced pain and disability, while improving quality of life. These outcomes can be achieved without paresthesias.
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Affiliation(s)
- Kenneth B Chapman
- The Spine & Pain Institute of New York, New York City, NY, USA.,Department of Anesthesiology, New York University Langone Medical Center, New York City, NY, USA.,Department of Anesthesiology and Pain Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Hempstead, New York, USA
| | - Pauline S Groenen
- The Spine & Pain Institute of New York, New York City, NY, USA.,College of Medicine, Radboud University, Nijmegen, The Netherlands
| | - Kiran V Patel
- The Spine & Pain Institute of New York, New York City, NY, USA.,Department of Anesthesiology and Pain Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Hempstead, New York, USA
| | - Kris C Vissers
- Department of Anesthesiology, Pain, and Palliative Medicine, Radboud University, Nijmegen, The Netherlands
| | - Noud van Helmond
- The Spine & Pain Institute of New York, New York City, NY, USA.,Department of Anesthesiology, Cooper Medical School of Rowan University, Cooper University Hospital, Camden, NJ, USA
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84
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盛 恒, 磨 凯. [Role of ZHX2 in regulating dorsal root ganglion μ-opioid receptor expression in mice with peripheral nerve injuryinduced pain hypersensitivity]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2019; 39:917-922. [PMID: 31511211 PMCID: PMC6765599 DOI: 10.12122/j.issn.1673-4254.2019.08.07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To investigate the role of zinc-fingers and homeoboxes 2 (ZHX2) in regulating μ-opioid receptor expression in the dorsal root ganglion (DRG) in mice with peripheral nerve injury-induced pain hypersensitivity. METHODS Forty-eight male adult C57BL6J mice were randomized into 4 groups and subjected to chronic constriction injury (CCI) of the sciatic nerve or sham operation followed by microinjection of a specific small interfering RNA (siRNA) of ZHX2 or a negative control siRNA sequence (siNC) into the DRG. Seven days later, the mice were examined for changes in the hind paw withdrawal frequency (PWF), after which the DRG tissue was collected for detecting the expressions of μ-opioid receptor at the mRNA and protein levels using RT-qPCR and Western blotting. In another experiment, the DRG tissues were collected from 6 mice (21-day-old) for primary culture of the DRG neurons, which were transfected with ZHX2 siRNA or the siNC to observe the changes in the expressions of ZHX2 and μ-pioid receptor. RESULTS Microinjection of ZHX2 siRNA into the ipsilateral L3 and L4 DRGs significantly reversed CCI-induced μ-pioid receptor downregulation in the injured DRG and alleviated CCI-induced mechanical allodynia in the mice. In the cell experiment, ZHX2 knockdown obviously upregulated the mRNA and protein expressions of opioid receptor in the primary cultured DRG neurons. CONCLUSIONS ZHX2 knockdown in the DRG reverses CCI-induced down-regulation of μ opioid receptor to alleviate periphery nerve injury-induced pain hypersensitivity in mice.
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Affiliation(s)
- 恒炜 盛
- 南部战区总医院麻醉科,广东 广州 510010Department of Anesthesiology, General Hospital of Southern Theatre Command, Guangzhou 510010, China
| | - 凯 磨
- 南方医科大学珠江医院麻醉科,广东 广州 510282Department of Anesthesiology, Zhujiang Hospital, Southern Medical University, Guangzhou 510282, China
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85
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Perturbations in neuroinflammatory pathways are associated with paclitaxel-induced peripheral neuropathy in breast cancer survivors. J Neuroimmunol 2019; 335:577019. [PMID: 31401418 PMCID: PMC6788784 DOI: 10.1016/j.jneuroim.2019.577019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 07/18/2019] [Accepted: 08/01/2019] [Indexed: 01/11/2023]
Abstract
Paclitaxel is a common chemotherapy drug associated with the development of chronic paclitaxel-induced peripheral neuropathy (PIPN). PIPN is associated with neuroinflammatory mechanisms in pre-clinical studies. Here, we evaluated for differential gene expression (DGE) in peripheral blood between breast cancer survivors with and without PIPN and for neuroinflammatory (NI) related signaling pathways and whole-transcriptome profiles from other experiments. Pathway impact analysis identified 8 perturbed NI related pathways. Expression profile analysis found 15 experiments having similar whole-transcriptome profiles of DGE related to neuroinflammation and PIPN. These findings suggest that perturbations in pathways associated with neuroinflammation are found in cancer survivors with PIPN. Paclitaxel-induced peripheral neuropathy (PIPN) is associated with Paclitaxel treatment Differential gene expression was associated with PIPN in breast cancer survivors. Perturbations of neuroinflammatory-related pathways were identified between survivors. Transcriptome profile was similar to other pre-clinical and clinical studies.
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86
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Advanced glycation endproducts produced by in vitro glycation of type I collagen modulate the functional and secretory behavior of dorsal root ganglion cells cultivated in two-dimensional system. Exp Cell Res 2019; 382:111475. [PMID: 31255600 DOI: 10.1016/j.yexcr.2019.06.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 06/15/2019] [Accepted: 06/19/2019] [Indexed: 12/24/2022]
Abstract
Advanced glycation end-products (AGEs) are proteins/lipids that are glycated upon sugar exposure and are often increased during inflammatory diseases such as osteoarthritis and neurodegenerative disorders. Here, we developed an extracellular matrix (ECM) using glycated type I collagen (ECM-GC), which produced similar levels of AGEs to those detected in the sera of arthritic mice. In order to determine whether AGEs were sufficient to stimulate sensory neurons, dorsal root ganglia (DRGs) cells were cultured on ECM-GC or ECM-NC-coated plates. ECM-GC or ECM-NC were favorable for DRG cells expansion. However, ECM-GC cultivated neurons displayed thinner F-actin filaments, rounded morphology, and reduced neuron interconnection compared to ECM-NC. In addition, ECM-GC did not affect RAGE expression levels in the neurons, although induced rapid p38, MAPK and ERK activation. Finally, ECM-GC stimulated the secretion of nitrite and TNF-α by DRG cells. Taken together, our in vitro glycated ECM model suitably mimics the in vivo microenvironment of inflammatory disorders and provides new insights into the role of ECM impairment as a nociceptive stimulus.
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Strategies for interventional therapies in cancer-related pain-a crossroad in cancer pain management. Support Care Cancer 2019; 27:3133-3145. [PMID: 31093769 DOI: 10.1007/s00520-019-04827-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 04/23/2019] [Indexed: 12/28/2022]
Abstract
PURPOSE Interventional therapies are important to consider when facing cancer pain refractory to conventional therapies. The objective of the current review is to introduce these effective strategies into dynamic interdisciplinary pain management, leading to an exhaustive approach to supportive oncology. METHODS Critical reflection based on literature analysis and clinical practice. RESULTS Interventional therapies act on the nervous system via neuromodulation or surgical approaches, or on primitive or metastatic lesions via interventional radiotherapy, percutaneous ablation, or surgery. Interventional therapies such as neuromodulations are constantly evolving with new technical works still in development. Nowadays, their usage is better defined, depending on clinical situations, and their impact on quality of life is proven. Nevertheless their availability and acceptability still need to be improved. To start with, a patient's interdisciplinary evaluation should cover a wide range of items such as patient's performance and psychological status, ethical considerations, and physiochemical and pharmacological properties of the cerebrospinal fluid for intrathecal neuromodulation. This will help to define the most appropriate strategy. In addition to determining the pros and cons of highly specialized interventional therapies, their relevance should be debated within interdisciplinary teams in order to select the best strategy for the right patient, at the right time. CONCLUSIONS Ultimately, the use of the interventional therapies can be limited by the requirement of specific trained healthcare teams and technical support, or the lack of health policies. However, these interventional strategies need to be proposed as soon as possible to each patient requiring them, as they can greatly improve quality of life.
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88
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Liang YX, Wang NN, Zhang ZY, Juan ZD, Zhang C. Necrostatin-1 Ameliorates Peripheral Nerve Injury-Induced Neuropathic Pain by Inhibiting the RIP1/RIP3 Pathway. Front Cell Neurosci 2019; 13:211. [PMID: 31156396 PMCID: PMC6529821 DOI: 10.3389/fncel.2019.00211] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 04/26/2019] [Indexed: 12/22/2022] Open
Abstract
Necrostatin-1 is an inhibitor of necroptosis, a form of programmed cell death that has been reported to be involved in various neurological diseases. Presently, the role of necroptosis in neuropathic pain induced by peripheral nerve injury is still unclear. This study was focused on investigating the potential effects of necroptosis in the development and progression of neuropathic pain in a rat model and the possible neuroprotective effects of necrostatin-1 in neuropathic pain. The results indicated that the necroptosis-related proteins RIP1 and RIP3 significantly increased postoperation in the spinal cord in a neuropathic pain model and peaked 7 days postoperation, which was consistent with the time-dependent changes of hyperalgesia. Additionally, we found that peripheral nerve injury-related behavioral and biochemical changes were significantly reduced by necrostatin-1. In particular, hyperalgesia was attenuated, and the levels of RIP1 and RIP3 were decreased. Furthermore, the ultrastructure of necrotic cell death and neuroinflammation were alleviated by necrostatin-1. Collectively, these results suggest that necroptosis is an important mechanism of cell death in neuropathic pain induced by peripheral nerve injury and that necrostatin-1 may be a promising neuroprotective treatment for neuropathic pain.
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Affiliation(s)
- Ying-Xia Liang
- Medicine and Health Key Laboratory of Clinical Anesthesia, Department of Anesthesiology, Weifang Medical University, Weifang, China.,Genetics and Aging Research Unit, Department of Neurology, MassGeneral Institute for Neurodegenerative Disease, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, United States
| | - Nan-Nan Wang
- Medicine and Health Key Laboratory of Clinical Anesthesia, Department of Anesthesiology, Weifang Medical University, Weifang, China
| | - Zhi-Yu Zhang
- Department of Microsurgery, Shouguang People's Hospital, Weifang, China
| | - Zhao-Dong Juan
- Medicine and Health Key Laboratory of Clinical Anesthesia, Department of Anesthesiology, Weifang Medical University, Weifang, China
| | - Can Zhang
- Genetics and Aging Research Unit, Department of Neurology, MassGeneral Institute for Neurodegenerative Disease, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, United States
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89
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Singh S, Kartha S, Bulka BA, Stiansen NS, Winkelstein BA. Physiologic facet capsule stretch can induce pain & upregulate matrix metalloproteinase-3 in the dorsal root ganglia when preceded by a physiological mechanical or nonpainful chemical exposure. Clin Biomech (Bristol, Avon) 2019; 64:122-130. [PMID: 29523370 PMCID: PMC6067996 DOI: 10.1016/j.clinbiomech.2018.01.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 12/22/2017] [Accepted: 01/15/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Neck pain from cervical facet loading is common and induces inflammation and upregulation of nerve growth factor (NGF) that can sensitize the joint afferents. Yet, the mechanisms by which these occur and whether afferents can be pre-conditioned by certain nonpainful stimuli are unknown. This study tested the hypothesis that a nonpainful mechanical or chemical insult predisposes a facet joint to generate pain after a later exposure to typically nonpainful distraction. METHODS Rats were exposed to either a nonpainful distraction or an intra-articular subthreshold dose of NGF followed by a nonpainful distraction two days later. Mechanical hyperalgesia was measured daily and C6 dorsal root ganglia (DRG) tissue was assayed for NGF and matrix metalloproteinase-3 (MMP-3) expression on day 7. FINDINGS The second distraction increased joint displacement and strains compared to its first application (p = 0.0011). None of the initial exposures altered behavioral sensitivity in either of the groups being pre-conditioned or in controls; but, sensitivity was established in both groups receiving a second distraction within one day that lasted until day 7 (p < 0.024). NGF expression in the DRG was increased in both groups undergoing a pre-conditioning exposure (p < 0.0232). Similar findings were observed for MMP-3 expression, with a pre-conditioning exposure increasing levels after an otherwise nonpainful facet distraction. INTERPRETATION These findings suggest that nonpainful insults to the facet joint, when combined, can generate painful outcomes, possibly mediated by upregulation of MMP-3 and mature NGF.
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Affiliation(s)
- Sagar Singh
- Department of Bioengineering, University of Pennsylvania, 210 S. 33rd Street, 240 Skirkanich Hall, Philadelphia, PA 19104, USA
| | - Sonia Kartha
- Department of Bioengineering, University of Pennsylvania, 210 S. 33rd Street, 240 Skirkanich Hall, Philadelphia, PA 19104, USA
| | - Ben A Bulka
- Department of Bioengineering, University of Pennsylvania, 210 S. 33rd Street, 240 Skirkanich Hall, Philadelphia, PA 19104, USA
| | - Nicholas S Stiansen
- Department of Bioengineering, University of Pennsylvania, 210 S. 33rd Street, 240 Skirkanich Hall, Philadelphia, PA 19104, USA
| | - Beth A Winkelstein
- Department of Bioengineering, University of Pennsylvania, 210 S. 33rd Street, 240 Skirkanich Hall, Philadelphia, PA 19104, USA; Department of Neurosurgery, University of Pennsylvania, 210 S. 33rd Street, 240 Skirkanich Hall, Philadelphia, PA 19104, USA.
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90
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Vuka I, Marciuš T, Došenović S, Ferhatović Hamzić L, Vučić K, Sapunar D, Puljak L. Neuromodulation with electrical field stimulation of dorsal root ganglion in various pain syndromes: a systematic review with focus on participant selection. J Pain Res 2019; 12:803-830. [PMID: 30881093 PMCID: PMC6398970 DOI: 10.2147/jpr.s168814] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Objective We conducted a systematic review about patient selection, efficacy, and safety of neuromodulation with electrical field stimulation (EFS) of dorsal root ganglion (DRG) in various painful conditions. We also analyzed conclusion statements as well as conflict of interest and financing of the included studies. Methods All study designs were eligible for inclusion. We searched MEDLINE, CINAHL, Embase, PsycINFO, and clinical trial registries until September 7, 2018. We assessed risk of bias by using Cochrane tool for randomized controlled trials (RCTs). Results Among the 29 included studies, only one was RCT, majority being case series and case reports. The evidence is based on studies with small number of participants (median: 6, range 1–152) with various painful conditions. Neuromodulation with EFS of DRG was mostly performed in participants who have failed other treatment modalities. Most of the authors of the included studies reported positive, but inconclusive, evidence regarding efficacy of neuro-modulation with EFS of DRG. Meta-analysis was not possible since only one RCT was included. Conclusion Available evidence suggest that neuromodulation with EFS of DRG may help highly selected participants with various pain syndromes, who have failed to achieve adequate pain relief with other pharmacological and nonpharmacological interventions. However, these findings should be confirmed in high-quality RCTs with sufficient numbers of participants.
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Affiliation(s)
- Ivana Vuka
- Laboratory for Pain Research, University of Split School of Medicine, 21000 Split, Croatia
| | - Tihana Marciuš
- Laboratory for Pain Research, University of Split School of Medicine, 21000 Split, Croatia
| | - Svjetlana Došenović
- Department of Anesthesiology, Reanimatology and Intensive Care, University Hospital Split, 21000 Split, Croatia
| | - Lejla Ferhatović Hamzić
- Department for Proteomics, Center for Translational and Clinical Research, University of Zagreb School of Medicine, 10000 Zagreb, Croatia
| | - Katarina Vučić
- Department for Safety and Efficacy Assessment of Medicinal Products, Agency for Medicinal Products and Medical Devices, 10000 Zagreb, Croatia
| | - Damir Sapunar
- Laboratory for Pain Research, University of Split School of Medicine, 21000 Split, Croatia.,Center for Evidence-Based Medicine and Health Care, Catholic University of Croatia, 10000 Zagreb, Croatia,
| | - Livia Puljak
- Center for Evidence-Based Medicine and Health Care, Catholic University of Croatia, 10000 Zagreb, Croatia,
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91
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Verrills P, Mitchell B, Vivian D, Cusack W, Kramer J. Dorsal Root Ganglion Stimulation Is Paresthesia-Independent: A Retrospective Study. Neuromodulation 2019; 22:937-942. [PMID: 30701632 DOI: 10.1111/ner.12921] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 11/20/2018] [Accepted: 12/04/2018] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Neuromodulation is an important tool for achieving pain relief in otherwise-intractable neuropathic pain conditions. Dorsal root ganglion (DRG) stimulation, in which primary sensory neurons are stimulated prior to their entry into the spinal canal, provides treatment with high levels of dermatomal specificity and can provide advantages compared to conventional spinal cord stimulation. Although DRG stimulation can produce perceptible paresthesias, many patients operate their systems at subthreshold amplitudes that do not elicit this sensation. Pain relief both with and without paresthesia was investigated in this retrospective analysis. MATERIALS AND METHODS A retrospective review of all qualifying permanent DRG stimulation systems at a single center over more than a three-year period was completed. Pain (0-10 numeric rating scale) was assessed at baseline, at the end of the trial, and after three, six, and twelve months of treatment. Patients were categorized based on their usage of the stimulator at amplitudes that either did or did not produce paresthesias. RESULTS Of the 39 patients, 34 (87%) reported having no-paresthesias at any of the follow-up visits. Average pain relief was 73.9% after the trial period and 63.1% after 12 months of treatment. The responder rate (50% or better pain relief) after three months of treatment was more than 80%. Exploratory subgroup analyses showed that similar degrees of pain relief were achieved in numerous body regions and with various pain etiologies. The five patients who reported paresthesias during treatment had pain relief similar to those of the group that did not experience paresthesias. DISCUSSION Clinically significant and sustained pain relief over more than a period of 12 months was achieved with DRG stimulation programmed at amplitudes below the perceptual level. Thus, the reported analgesia was paresthesia-independent. That good clinical outcomes were observed independent of the generation of paresthesia in DRG stimulation suggests several mechanisms of action, including the inhibition of supraspinal regions involved in somatic paresthesia sensation. The retrospective results presented here posit that future prospective study of DRG stimulation delivered at below the threshold of perceptible paresthesias is warranted.
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92
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Gomez-Varela D, Barry AM, Schmidt M. Proteome-based systems biology in chronic pain. J Proteomics 2019; 190:1-11. [DOI: 10.1016/j.jprot.2018.04.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Revised: 03/15/2018] [Accepted: 04/05/2018] [Indexed: 02/07/2023]
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93
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Morgalla MH, de Barros Filho MF, Chander BS, Soekadar SR, Tatagiba M, Lepski G. Neurophysiological Effects of Dorsal Root Ganglion Stimulation (DRGS) in Pain Processing at the Cortical Level. Neuromodulation 2018; 22:36-43. [PMID: 30561852 DOI: 10.1111/ner.12900] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Revised: 10/25/2018] [Accepted: 10/25/2018] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Dorsal root ganglion stimulation (DRGS) has been used successfully against localized neuropathic pain. Nevertheless, the effects of DRGS on pain processing, particularly at the cortical level, remain largely unknown. In this study, we investigated whether positive responses to DRGS treatment would alter patients' laser-evoked potentials (LEP). METHODS We prospectively enrolled 12 adult patients with unilateral localized neuropathic pain in the lower limbs or inguinal region and followed them up for six months. LEPs were assessed at baseline, after one month of DRGS, and after six months of DRGS. Clinical assessment included the Numerical Rating Scale (NRS), Brief Pain Inventory (BPI), SF-36, and Beck Depression Inventory (BDI). For each patient, LEP amplitudes and latencies of the N2 and P2 components on the deafferented side were measured and compared to those of the healthy side and correlated with pain intensity, as measured with the NRS. RESULTS At the one- and six-month follow-ups, N2-P2 amplitudes were significantly greater and NRS scores were significantly lower compared with baseline (all p's < 0.01). There was a negative correlation between LEP amplitudes and NRS scores (rs = -0.31, p < 0.10). CONCLUSIONS DRGS is able to restore LEPs to normal values in patients with localized neuropathic pain, and LEP alterations are correlated with clinical response in terms of pain intensity.
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Affiliation(s)
| | - Marcos Fortunato de Barros Filho
- Department of Neurosurgery, University of Tuebingen, Tuebingen, Germany.,Applied Neurotechnology Laboratory, Department of Psychiatry and Psychotherapy, University of Tuebingen, Tuebingen, Germany.,Division of Functional Neurosurgery, School of Medicine, Universidade de São Paulo, São Paulo, Brazil
| | - Bankim Subhash Chander
- Department of Neurosurgery, University of Tuebingen, Tuebingen, Germany.,Applied Neurotechnology Laboratory, Department of Psychiatry and Psychotherapy, University of Tuebingen, Tuebingen, Germany
| | - Surjo Raphael Soekadar
- Applied Neurotechnology Laboratory, Department of Psychiatry and Psychotherapy, University of Tuebingen, Tuebingen, Germany.,Clinical Neurotechnology Laboratory, Neuroscience Research Center (NWFZ) & Department of Psychiatry and Psychotherapy, Charité - University Medicine Berlin, Berlin, Germany
| | - Marcos Tatagiba
- Department of Neurosurgery, University of Tuebingen, Tuebingen, Germany
| | - Guilherme Lepski
- Department of Neurosurgery, University of Tuebingen, Tuebingen, Germany.,Division of Functional Neurosurgery, School of Medicine, Universidade de São Paulo, São Paulo, Brazil
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Wu S, Bono J, Tao YX. Long noncoding RNA (lncRNA): a target in neuropathic pain. Expert Opin Ther Targets 2018; 23:15-20. [PMID: 30451044 DOI: 10.1080/14728222.2019.1550075] [Citation(s) in RCA: 80] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Current treatments for neuropathic pain are limited in part due to the incomplete understanding of its underlying mechanisms. Recent evidence reveals the dysregulated expression of long non-coding RNAs (lncRNAs) in the damaged nerve, dorsal root ganglion (DRG), and spinal cord dorsal horn following peripheral nerve injury. However, the role of the majority of lncRNAs in neuropathic pain genesis is still elusive. Unveiling the mechanisms of how lncRNAs participate in neuropathic pain may develop new strategies to prevent and/or treat this disorder. Areas covered: This review focuses on the dysregulation of lncRNAs in the DRG, dorsal horn, and the injured nerves from preclinical models of neuropathic pain. We provide evidence of how peripheral nerve injury causes the dysregulation of lncRNAs in these pain-related regions. The potential mechanisms of how dysregulated lncRNAs contribute to the pathogenesis of neuropathic pain are discussed. Expert opinion: The investigation on the role of the dysregulated lncRNAs in neuropathic pain might open up a novel avenue for therapeutic treatment of this disorder. However, current investigation is at the infancy stage, which challenges the translation of preclinical findings. More intensive studies on lncRNAs are required before the preclinical findings are translated into therapeutic management for neuropathic pain.
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Affiliation(s)
- Shaogen Wu
- a Department of Anesthesiology , New Jersey Medical School, Rutgers, The State University of New Jersey , Newark , NJ , USA
| | - Jamie Bono
- a Department of Anesthesiology , New Jersey Medical School, Rutgers, The State University of New Jersey , Newark , NJ , USA
| | - Yuan-Xiang Tao
- a Department of Anesthesiology , New Jersey Medical School, Rutgers, The State University of New Jersey , Newark , NJ , USA
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Abstract
Spinal cord stimulation (SCS) is a neuromodulation therapy used to treat medically refractory chronic pain. In SCS, an implanted pulse generator produces electrical signals that are conveyed through electrode arrays located in the region of the spinal cord. The goal of SCS is to modulate neural signaling through spinal and supraspinal mechanisms to reduce pain. Although available for decades, SCS still enjoys only limited clinical success, limited quality-of-life improvement, and limited long-term efficacy. To improve SCS outcomes, advances in lead design, stimulator features, and waveform paradigms have been recently introduced. While it is an exciting time for the neuromodulation field, empirical SCS advances have surpassed scientific understanding of SCS mechanisms of action. We still do not know why SCS works in some patients but not in others. We also lack information-rich biomarkers of pain and pain relief through which to optimize SCS programming. To optimize both system designs and clinical implementations of SCS, it is critical that we address these scientific and mechanistic knowledge gaps.
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Affiliation(s)
- Scott F. Lempka
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA
- Biointerfaces Institute, University of Michigan, Ann Arbor, MI, USA
| | - Parag G. Patil
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA
- Department of Neurosurgery, University of Michigan, Ann Arbor, MI, USA
- Department of Neurology, University of Michigan, Ann Arbor, MI, USA
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96
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Zhang Y, Wang M, Lu Q, Li Q, Lin M, Huang J, Hong Y. Inhibitory Effects of Mas-Related Gene C Receptor on Chronic Morphine-Induced Spinal Glial Activation in Rats. J Pharmacol Exp Ther 2018; 368:237-245. [DOI: 10.1124/jpet.118.252494] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Accepted: 11/20/2018] [Indexed: 12/20/2022] Open
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97
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Zhang H, Kashihara T, Nakada T, Tanaka S, Ishida K, Fuseya S, Kawagishi H, Kiyosawa K, Kawamata M, Yamada M. Prostanoid EP4 Receptor-Mediated Augmentation of I h Currents in A β Dorsal Root Ganglion Neurons Underlies Neuropathic Pain. J Pharmacol Exp Ther 2018; 368:50-58. [PMID: 30409832 DOI: 10.1124/jpet.118.252767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Accepted: 11/05/2018] [Indexed: 11/22/2022] Open
Abstract
An injury of the somatosensory system causes neuropathic pain, which is usually refractory to conventional analgesics, thus warranting the development of novel drugs against this kind of pain. The mechanism of neuropathic pain in rats that had undergone left L5 spinal nerve transection was analyzed. Ten days after surgery, these rats acquired neuropathic pain. The patch-clamp technique was used on the isolated bilateral L5 dorsal root ganglion neurons. The current-clamped neurons on the ipsilateral side exhibited significantly higher excitability than those on the contralateral side. However, only neurons with diameters of 40-50 μm on the ipsilateral side exhibited significantly larger voltage sags in response to hyperpolarizing current pulses than those on the contralateral side. Under the voltage clamp, only these neurons on the ipsilateral side showed a significantly larger density of an inward current at < -80 mV [hyperpolarization-activated nonselective cation (I h) current] with a rightward-shifted activation curve than that on the contralateral side. Ivabradine-an I h current inhibitor-inhibited I h currents in these neurons on both sides in a similar concentration-dependent manner, with an IC50 value of ∼3 μM. Moreover, the oral administration of ivabradine significantly alleviated the neuropathic pain on the ipsilateral side. An inhibitor of adenylyl cyclase or an antagonist of prostanoid EP4 receptors (CJ-023423) inhibited ipsilateral, but not contralateral I h, currents in these neurons. Furthermore, the intrathecal administration of CJ-023423 significantly attenuated neuropathic pain on the ipsilateral side. Thus, ivabradine and/or CJ-023423 may be a lead compound for the development of novel therapeutics against neuropathic pain.
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Affiliation(s)
- Hao Zhang
- Departments of Molecular Pharmacology (H.Z., T.K., T.N., H.K., K.K., M.Y.) and Anesthesiology and Resuscitology (H.Z., S.T., K.I., S.F., K.K., M.K.), Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Toshihide Kashihara
- Departments of Molecular Pharmacology (H.Z., T.K., T.N., H.K., K.K., M.Y.) and Anesthesiology and Resuscitology (H.Z., S.T., K.I., S.F., K.K., M.K.), Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Tsutomu Nakada
- Departments of Molecular Pharmacology (H.Z., T.K., T.N., H.K., K.K., M.Y.) and Anesthesiology and Resuscitology (H.Z., S.T., K.I., S.F., K.K., M.K.), Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Satoshi Tanaka
- Departments of Molecular Pharmacology (H.Z., T.K., T.N., H.K., K.K., M.Y.) and Anesthesiology and Resuscitology (H.Z., S.T., K.I., S.F., K.K., M.K.), Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Kumiko Ishida
- Departments of Molecular Pharmacology (H.Z., T.K., T.N., H.K., K.K., M.Y.) and Anesthesiology and Resuscitology (H.Z., S.T., K.I., S.F., K.K., M.K.), Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Satoshi Fuseya
- Departments of Molecular Pharmacology (H.Z., T.K., T.N., H.K., K.K., M.Y.) and Anesthesiology and Resuscitology (H.Z., S.T., K.I., S.F., K.K., M.K.), Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Hiroyuki Kawagishi
- Departments of Molecular Pharmacology (H.Z., T.K., T.N., H.K., K.K., M.Y.) and Anesthesiology and Resuscitology (H.Z., S.T., K.I., S.F., K.K., M.K.), Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Kenkichi Kiyosawa
- Departments of Molecular Pharmacology (H.Z., T.K., T.N., H.K., K.K., M.Y.) and Anesthesiology and Resuscitology (H.Z., S.T., K.I., S.F., K.K., M.K.), Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Mikito Kawamata
- Departments of Molecular Pharmacology (H.Z., T.K., T.N., H.K., K.K., M.Y.) and Anesthesiology and Resuscitology (H.Z., S.T., K.I., S.F., K.K., M.K.), Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Mitsuhiko Yamada
- Departments of Molecular Pharmacology (H.Z., T.K., T.N., H.K., K.K., M.Y.) and Anesthesiology and Resuscitology (H.Z., S.T., K.I., S.F., K.K., M.K.), Shinshu University School of Medicine, Matsumoto, Nagano, Japan
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98
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Mo K, Xu H, Gong H, Lei H, Wang Y, Guo W, Xu S, Tu W. Dorsal Root Ganglia Coactivator-associated Arginine Methyltransferase 1 Contributes to Peripheral Nerve Injury-induced Pain Hypersensitivities. Neuroscience 2018; 394:232-242. [PMID: 30391528 DOI: 10.1016/j.neuroscience.2018.10.038] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 10/17/2018] [Accepted: 10/22/2018] [Indexed: 10/28/2022]
Abstract
Neuropathic pain is associated with gene expression changes within the dorsal root ganglion (DRG) after peripheral nerve injury, which involves epigenetic mechanisms. Coactivator-associated arginine methyltransferase 1 (CARM1), an epigenetic activator, regulates gene transcriptional activity by protein posttranslational modifications. However, whether CARM1 plays an essential role in the development and maintenance of neuropathic pain is unknown. We report here that peripheral nerve injury induced the upregulation of the mRNA and protein expression of CARM1 in the injured DRG, and blocking its expression through small interfering RNA (siRNA) in the injured DRG attenuated the development and maintenance of neuropathic pain. Furthermore, pharmacological inhibition of CARM1 mitigated peripheral nerve injury-induced mechanical allodynia and thermal hyperalgesia. Given that CARM1 inhibition or knockdown attenuated the induction and maintenance of neuropathic pain after peripheral nerve injury, our findings suggest that CARM1 may serve as a promising therapeutic target for neuropathic pain treatment in clinical applications.
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Affiliation(s)
- Kai Mo
- Department of Anesthesiology, Guangzhou General Hospital of Guangzhou Military Command, Southern Medical University (Guangzhou School of Clinic Medicine, Southern Medical University), Guangzhou 510010, China; Department of Anesthesiology, Zhujiang Hospital, Southern Medical University, Guangzhou 510280, China
| | - Huali Xu
- Department of Anesthesiology, Zhujiang Hospital, Southern Medical University, Guangzhou 510280, China
| | - Hualei Gong
- Department of Anesthesiology, Zhujiang Hospital, Southern Medical University, Guangzhou 510280, China
| | - Hongyi Lei
- Department of Anesthesiology, Zhujiang Hospital, Southern Medical University, Guangzhou 510280, China
| | - Yongwei Wang
- Department of Anesthesiology, Zhujiang Hospital, Southern Medical University, Guangzhou 510280, China
| | - Wenjing Guo
- Department of Anesthesiology, Zhujiang Hospital, Southern Medical University, Guangzhou 510280, China
| | - Shiyuan Xu
- Department of Anesthesiology, Zhujiang Hospital, Southern Medical University, Guangzhou 510280, China
| | - Weifeng Tu
- Department of Anesthesiology, Guangzhou General Hospital of Guangzhou Military Command, Southern Medical University (Guangzhou School of Clinic Medicine, Southern Medical University), Guangzhou 510010, China.
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Chakravarthy KV, Xing F, Bruno K, Kent AR, Raza A, Hurlemann R, Kinfe TM. A Review of Spinal and Peripheral Neuromodulation and Neuroinflammation: Lessons Learned Thus Far and Future Prospects of Biotype Development. Neuromodulation 2018; 22:235-243. [DOI: 10.1111/ner.12859] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2018] [Revised: 07/18/2018] [Accepted: 08/15/2018] [Indexed: 12/21/2022]
Affiliation(s)
- Krishnan V. Chakravarthy
- Department of Anesthesiology and Pain MedicineUniversity of California San Diego Health Sciences San Diego CA USA
- VA San Diego Healthcare System San Diego CA USA
| | - Fang Xing
- Department of Anesthesiology and Pain MedicineBrigham and Women's Hospital Boston MA USA
| | - Kelly Bruno
- Department of Anesthesiology and Pain MedicineUniversity of California San Diego Health Sciences San Diego CA USA
- VA San Diego Healthcare System San Diego CA USA
| | | | - Adil Raza
- Neuromodulation Division, Abbott Plano TX USA
| | - Rene Hurlemann
- Department of Psychiatry, Division of Medical Psychology (NEMO Neuromodulation of Emotions)Rheinische Friedrich Wilhelms‐University Hospital Bonn Germany
| | - Thomas M. Kinfe
- Department of Psychiatry, Division of Medical Psychology (NEMO Neuromodulation of Emotions)Rheinische Friedrich Wilhelms‐University Hospital Bonn Germany
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100
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Deer TR, Pope JE, Lamer TJ, Grider JS, Provenzano D, Lubenow TR, FitzGerald JJ, Hunter C, Falowski S, Sayed D, Baranidharan G, Patel NK, Davis T, Green A, Pajuelo A, Epstein LJ, Harned M, Liem L, Christo PJ, Chakravarthy K, Gilmore C, Huygen F, Lee E, Metha P, Nijhuis H, Patterson DG, Petersen E, Pilitsis JG, Rowe JJ, Rupert MP, Skaribas I, Sweet J, Verrills P, Wilson D, Levy RM, Mekhail N. The Neuromodulation Appropriateness Consensus Committee on Best Practices for Dorsal Root Ganglion Stimulation. Neuromodulation 2018; 22:1-35. [PMID: 30246899 DOI: 10.1111/ner.12845] [Citation(s) in RCA: 89] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 05/03/2018] [Accepted: 05/29/2018] [Indexed: 12/21/2022]
Abstract
INTRODUCTION The Neuromodulation Appropriateness Consensus Committee (NACC) is dedicated to improving the safety and efficacy of neuromodulation and thus improving the lives of patients undergoing neuromodulation therapies. With continued innovations in neuromodulation comes the need for evolving reviews of best practices. Dorsal root ganglion (DRG) stimulation has significantly improved the treatment of complex regional pain syndrome (CRPS), among other conditions. Through funding and organizational leadership by the International Neuromodulation Society (INS), the NACC reconvened to develop the best practices consensus document for the selection, implantation and use of DRG stimulation for the treatment of chronic pain syndromes. METHODS The NACC performed a comprehensive literature search of articles about DRG published from 1995 through June, 2017. A total of 2538 article abstracts were then reviewed, and selected articles graded for strength of evidence based on scoring criteria established by the US Preventive Services Task Force. Graded evidence was considered along with clinical experience to create the best practices consensus and recommendations. RESULTS The NACC achieved consensus based on peer-reviewed literature and experience to create consensus points to improve patient selection, guide surgical methods, improve post-operative care, and make recommendations for management of patients treated with DRG stimulation. CONCLUSION The NACC recommendations are intended to improve patient care in the use of this evolving therapy for chronic pain. Clinicians who choose to follow these recommendations may improve outcomes.
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Affiliation(s)
| | | | - Tim J Lamer
- Division of Pain Medicine, Department of Anesthesiology, Mayo Clinic, Rochester, MN, USA
| | - Jay S Grider
- UKHealthCare Pain Services, Department of Anesthesiology, University of Kentucky College of Medicine, Lexington, KY, USA
| | | | | | - James J FitzGerald
- Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford, UK.,Nuffield Department of Surgical Sciences, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - Corey Hunter
- Ainsworth Institute of Pain Management, New York, NY, USA
| | - Steven Falowski
- Functional Neurosurgery, St. Lukes University Health Network, Bethlehem, PA, USA
| | - Dawood Sayed
- University of Kansas Medical Center, Kansas City, KS, USA
| | | | - Nikunj K Patel
- Institute of Clinical Neurosciences, Department of Neurosurgery, Southmead Hospital, University of Bristol, Bristol, UK
| | | | - Alex Green
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | | | | | - Michael Harned
- Department of Anesthesiology, University of Kentucky, Lexington, KY, USA
| | - Liong Liem
- St. Antonius Hospital, Nieuwegein, The Netherlands
| | | | | | | | - Frank Huygen
- Erasmus University Hospital, Rotterdam, The Netherlands
| | - Eric Lee
- Summit Pain Alliance, Santa Rosa, CA, USA
| | | | | | | | - Erika Petersen
- Department of Neurosurgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Julie G Pilitsis
- Neurosurgery and Neuroscience & Experimental Therapeutics, Albany Medical College, Albany, NY, USA
| | | | | | | | - Jennifer Sweet
- Case Western Reserve University, Stereotactic & Functional Neurosurgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | | | - Derron Wilson
- Goodman Campbell Brain and Spine, Indiana University School of Medicine Department of Neurological Surgery, Indianapolis, IN, USA
| | | | - Nagy Mekhail
- Evidence-Based Pain Management Research and Education, Cleveland Clinic, Cleveland, OH, USA
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