101
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Evidence for Shared Pain Mechanisms in Osteoarthritis, Low Back Pain, and Fibromyalgia. Curr Rheumatol Rep 2011; 13:513-20. [DOI: 10.1007/s11926-011-0206-6] [Citation(s) in RCA: 97] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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102
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Lynch ME, Clark AJ, Moulin DE, Watson PN. Modifications are suggested for the Special Interest Group (SIG) on Neuropathic Pain proposed definition and guidelines for neuropathic pain. Pain 2011; 152:1682. [DOI: 10.1016/j.pain.2011.03.040] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2011] [Accepted: 03/28/2011] [Indexed: 10/18/2022]
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103
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Wilder-Smith OH. Chronic Pain and Surgery: A Review of New Insights from Sensory Testing. J Pain Palliat Care Pharmacother 2011; 25:146-59. [DOI: 10.3109/15360288.2010.505256] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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104
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Rapid synaptic remodeling in the adult somatosensory cortex following peripheral nerve injury and its association with neuropathic pain. J Neurosci 2011; 31:5477-82. [PMID: 21471384 DOI: 10.1523/jneurosci.0328-11.2011] [Citation(s) in RCA: 86] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Structural and functional plastic changes in the primary somatosensory cortex (S1) have been observed following peripheral nerve injury that often leads to neuropathic pain, which is characterized by tactile allodynia. However, remodeling of cortical connections following injury has been believed to take months or years; this is not temporally correlated with the rapid development of allodynia and S1 hyperexcitability. Here we first report, by using long-term two-photon imaging of postsynaptic dendritic spines in living adult mice, that synaptic connections in the S1 are rewired within days following sciatic nerve ligation through phase-specific and size-dependent spine survival/growth. Spine turnover in the S1 area corresponding to the injured paw markedly increased during an early phase of neuropathic pain and was restored in a late phase of neuropathic pain, which was prevented by immediate local blockade of the injured nerve throughout the early phase. New spines that generated before nerve injury showed volume decrease after injury, whereas more new spines that formed in the early phase of neuropathic pain became persistent and substantially increased their volume during the late phase. Further, preexisting stable spines survived less following injury than controls, and such lost persistent spines were smaller in size than the surviving ones, which displayed long-term potentiation-like enlargement over weeks. These results suggest that peripheral nerve injury induces rapid and selective remodeling of cortical synapses, which is associated with neuropathic pain development, probably underlying, at least partially, long-lasting sensory changes in neuropathic subjects.
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Abstract
Inadequately controlled pain is a significant problem during limb salvage and is associated with poor outcomes. This pain has several causes, and many management options exist. Chronic pain associated with limb salvage causes unnecessary suffering and negatively affects long-term function. Chronic pain and disability in this population may be prevented with early, aggressive, comprehensive treatment. Ongoing research into the cause and clinical course of limb salvage pain likely will lead to advances in pain management and functional improvement.
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106
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Cathcart S, Winefield AH, Lushington K, Rolan P. Stress and tension-type headache mechanisms. Cephalalgia 2011; 30:1250-67. [PMID: 20873360 DOI: 10.1177/0333102410362927] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Stress is widely demonstrated as a contributing factor in tension-type headache (TTH). The mechanisms underlying this remain unclear at present. Recent research indicates the importance of central pain processes in tension-type headache (TTH) pathophysiology. Concurrently, research with animals and healthy humans has begun to elucidate the relationship between stress and pain processing in the central nervous system, including central pain processes putatively dysfunctional in TTH. Combined, these two fields of research present new insights and hypotheses into possible mechanisms by which stress may contribute to TTH. To date, however, there has been no comprehensive review of this literature. The present paper provides such a review, which may be valuable in facilitating a broader understanding of the central mechanisms by which stress may contribute to TTH.
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Affiliation(s)
- Stuart Cathcart
- Centre for Applied Psychological Research, School of Psychology, University of South Australia, Adelaide, Australia.
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107
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Buvanendran A, Thillainathan V. Preoperative and postoperative anesthetic and analgesic techniques for minimally invasive surgery of the spine. Spine (Phila Pa 1976) 2010; 35:S274-80. [PMID: 21160390 DOI: 10.1097/brs.0b013e31820240f8] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A review of methods to optimize anesthesia and analgesia for minimally invasive spine procedures. OBJECTIVE To provide information to surgeons and anesthesiologists of methods to provide optimal anesthesia and pain control for minimally invasive spine surgery with an emphasis on preoperative planning. SUMMARY OF BACKGROUND DATA Postoperative pain management in patients undergoing minimally invasive spine surgery is a challenge for the perioperative anesthesiologist. In addition to the incisional pain, trauma to deeper tissues, such as ligaments, muscles, intervertebral discs, and periosteum are reasons for significant pain. The increasing number of minimally invasive surgeries and the need for improved and rapid return of the patient of functionality have brought the perioperative anesthesiologist and the surgeon closer. METHODS We undertook a review of the literature currently available on anesthesia and analgesia for minimally invasive spine surgery with an emphasis on preoperative planning. A large number of reports of randomized controlled clinical trials with respect to perioperative anesthetic and postoperative pain management for minimally invasive spine surgery are reviewed and the applicability of some of the principles and protocols used for other types of minimally invasive surgical procedures are placed in the context of spine surgery. RESULTS It is important to understand and implement a multimodal analgesic therapy during a patient's preoperative visits. Perioperative multimodal analgesia with a fast-track anesthetic protocol is also important and provided in the manuscript. This protocol poses a challenge to the anesthesiologist with respect to neurophysiologic monitoring, which requires further study. The postoperative analgesic management should be a continuance of the multimodal analgesia provided before surgery. Some drugs are not appropriate for patients undergoing fusion surgery because of their effect on bone healing. CONCLUSION An optimal preoperative, perioperative, and postoperative anesthesia and analgesia protocol is important to best possible pain relief and rapid return to normal function. Communication between the anesthesiologist and spine surgeon is important to achieve a protocol with the best short- and long-term outcomes for the benefit of the patient.
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108
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Stratton P, Berkley KJ. Chronic pelvic pain and endometriosis: translational evidence of the relationship and implications. Hum Reprod Update 2010; 17:327-46. [PMID: 21106492 DOI: 10.1093/humupd/dmq050] [Citation(s) in RCA: 256] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Many clinicians and patients believe that endometriosis-associated pain is due to the lesions. Yet causality remains an enigma, because pain symptoms attributed to endometriosis occur in women without endometriosis and because pain symptoms and severity correlate poorly with lesion characteristics. Most research and reviews focus on the lesions, not the pain. This review starts with the recognition that the experience of pain is determined by the central nervous system (CNS) and focuses on the pain symptoms. METHODS Comprehensive searches of Pubmed, Medline and Embase were conducted for current basic and clinical research on chronic pelvic pain and endometriosis. The information was mutually interpreted by a basic scientist and a clinical researcher, both in the field of endometriosis. The goal was to develop new ways to conceptualize how endometriosis contributes to pain symptoms in the context of current treatments and the reproductive tract. RESULTS Endometriotic lesions can develop their own nerve supply, thereby creating a direct and two-way interaction between lesions and the CNS. This engagement provides a mechanism by which the dynamic and hormonally responsive nervous system is brought directly into play to produce a variety of individual differences in pain that can, in some women, become independent of the disease itself. CONCLUSIONS Major advances in improving understanding and alleviating pain in endometriosis will likely occur if the focus changes from lesions to pain. In turn, how endometriosis affects the CNS would be best examined in the context of mechanisms underlying other chronic pain conditions.
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Affiliation(s)
- Pamela Stratton
- Program in Reproductive and Adult Endocrinology, Eunice Kennedy Shriver National Institute of Child Health and Development, National Institutes of Health, Bldg. 10, CRC, RM 1-3140, 10 Center Dr. MSC 1109, Bethesda, MD 20892-1109 USA.
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Portela DA, Otero PE, Tarragona L, Briganti A, Breghi G, Melanie P. Combined paravertebral plexus block and parasacral sciatic block in healthy dogs. Vet Anaesth Analg 2010; 37:531-41. [DOI: 10.1111/j.1467-2995.2010.00572.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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110
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Campiglia L, Consales G, De Gaudio AR. Pre-emptive analgesia for postoperative pain control: a review. Clin Drug Investig 2010; 30 Suppl 2:15-26. [PMID: 20670045 DOI: 10.2165/1158411-s0-000000000-00000] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Pain can play an important role at the social and psychological level; hence one of the major goals of anaesthesia is to control and reduce the incidence of postoperative pain. The use of an analgesia before surgical incision may offer one of the most innovative and promising strategies for better pain control throughout the perioperative period. Pre-emptive analgesia refers to pharmacological intervention initiated prior to a painful stimulus in order to inhibit nociceptive mechanisms before they are triggered. Pre-emptive analgesia has three objectives: to reduce pain resulting from the activation of inflammatory mechanisms triggered by surgical incision; to hinder the pain memory response of the central nervous system; and to ensure a good control of postoperative pain in order to avoid the development of chronic pain. The following provides an overview of the scientific rationale for pre-emptive analgesia alongside an overview of published systematic reviews and randomized clinical trials related to this topic.
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Affiliation(s)
- Laura Campiglia
- Anaesthesiology, Intensive-Care Unit and Pain Therapy Department, Misericordia e Dolce Hospital, Prato, Italy.
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111
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Mas-related G-protein-coupled receptors inhibit pathological pain in mice. Proc Natl Acad Sci U S A 2010; 107:15933-8. [PMID: 20724664 DOI: 10.1073/pnas.1011221107] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
An important objective of pain research is to identify novel drug targets for the treatment of pathological persistent pain states, such as inflammatory and neuropathic pain. Mas-related G-protein-coupled receptors (Mrgprs) represent a large family of orphan receptors specifically expressed in small-diameter nociceptive primary sensory neurons. To determine the roles of Mrgprs in persistent pathological pain states, we exploited a mouse line in which a chromosomal locus spanning 12 Mrgpr genes was deleted (KO). Initial studies indicated that these KO mice show prolonged mechanical- and thermal-pain hypersensitivity after hind-paw inflammation compared with wild-type littermates. Here, we show that this mutation also enhances the windup response of dorsal-horn wide dynamic-range neurons, an electrophysiological model for the triggering of central pain sensitization. Deletion of the Mrgpr cluster also blocked the analgesic effect of intrathecally applied bovine adrenal medulla peptide 8-22 (BAM 8-22), an MrgprC11 agonist, on both inflammatory heat hyperalgesia and neuropathic mechanical allodynia. Spinal application of bovine adrenal medulla peptide 8-22 also significantly attenuated windup in wild-type mice, an effect eliminated in KO mice. These data suggest that members of the Mrgpr family, in particular MrgprC11, may constitute an endogenous inhibitory mechanism for regulating persistent pain in mice. Agonists for these receptors may, therefore, represent a class of antihyperalgesics for treating persistent pain with minimal side effects because of the highly specific expression of their targets.
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Manchikanti L, Singh V, Falco FJE, Cash KA, Pampati V. Evaluation of lumbar facet joint nerve blocks in managing chronic low back pain: a randomized, double-blind, controlled trial with a 2-year follow-up. Int J Med Sci 2010; 7:124-35. [PMID: 20567613 PMCID: PMC2880841 DOI: 10.7150/ijms.7.124] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2010] [Accepted: 05/26/2010] [Indexed: 02/07/2023] Open
Abstract
STUDY DESIGN A randomized, double-blind, controlled trial. OBJECTIVE To determine the clinical effectiveness of therapeutic lumbar facet joint nerve blocks with or without steroids in managing chronic low back pain of facet joint origin. SUMMARY OF BACKGROUND DATA Lumbar facet joints have been shown as the source of chronic pain in 21% to 41% of low back patients with an average prevalence of 31% utilizing controlled comparative local anesthetic blocks. Intraarticular injections, medial branch blocks, and radiofrequency neurotomy of lumbar facet joint nerves have been described in the alleviation of chronic low back pain of facet joint origin. METHODS The study included 120 patients with 60 patients in each group with local anesthetic alone or local anesthetic and steroids. The inclusion criteria was based upon a positive response to diagnostic controlled, comparative local anesthetic lumbar facet joint blocks.Outcome measures included the numeric rating scale (NRS), Oswestry Disability Index (ODI), opioid intake, and work status, at baseline, 3, 6, 12, 18, and 24 months. RESULTS Significant improvement with significant pain relief of >or= 50% and functional improvement of >or= 40% were observed in 85% in Group 1, and 90% in Group II, at 2-year follow-up.The patients in the study experienced significant pain relief for 82 to 84 weeks of 104 weeks, requiring approximately 5 to 6 treatments with an average relief of 19 weeks per episode of treatment. CONCLUSIONS Therapeutic lumbar facet joint nerve blocks, with or without steroids, may provide a management option for chronic function-limiting low back pain of facet joint origin.
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Fleckenstein J, Kramer S, Offenbächer M, Schober G, Plischke H, Siebeck M, Mussack T, Hatz R, Lehmeyer L, Lang PM, Heindl B, Conzen P, Irnich D. Etoricoxib--preemptive and postoperative analgesia (EPPA) in patients with laparotomy or thoracotomy--design and protocols. Trials 2010; 11:66. [PMID: 20504378 PMCID: PMC2890651 DOI: 10.1186/1745-6215-11-66] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2010] [Accepted: 05/27/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Our objective was to report on the design and essentials of the Etoricoxib protocol- Preemptive and Postoperative Analgesia (EPPA) Trial, investigating whether preemptive analgesia with cox-2 inhibitors is more efficacious than placebo in patients who receive either laparotomy or thoracotomy. DESIGN AND METHODS The study is a 2 x 2 factorial armed, double blinded, bicentric, randomised placebo-controlled trial comparing (a) etoricoxib and (b) placebo in a pre- and postoperative setting. The total observation period is 6 months. According to a power analysis, 120 patients scheduled for abdominal or thoracic surgery will randomly be allocated to either the preemptive or the postoperative treatment group. These two groups are each divided into two arms. Preemptive group patients receive etoricoxib prior to surgery and either etoricoxib again or placebo postoperatively. Postoperative group patients receive placebo prior to surgery and either placebo again or etoricoxib after surgery (2 x 2 factorial study design). The Main Outcome Measure is the cumulative use of morphine within the first 48 hours after surgery (measured by patient controlled analgesia PCA). Secondary outcome parameters include a broad range of tests including sensoric perception and genetic polymorphisms. DISCUSSION The results of this study will provide information on the analgesic effectiveness of etoricoxib in preemptive analgesia and will give hints on possible preventive effects of persistent pain. TRIAL REGISTRATION NCT00716833.
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Wilder-Smith OH, Schreyer T, Scheffer GJ, Arendt-Nielsen L. Patients with Chronic Pain After Abdominal Surgery Show Less Preoperative Endogenous Pain Inhibition and More Postoperative Hyperalgesia: A Pilot Study. J Pain Palliat Care Pharmacother 2010; 24:119-28. [DOI: 10.3109/15360281003706069] [Citation(s) in RCA: 144] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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115
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Jensen MP. A neuropsychological model of pain: research and clinical implications. THE JOURNAL OF PAIN 2010; 11:2-12. [PMID: 19595637 DOI: 10.1016/j.jpain.2009.05.001] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 02/11/2009] [Revised: 04/02/2009] [Indexed: 01/17/2023]
Abstract
UNLABELLED This focus article argues that it may be useful to consider, and expand research into, studying the associations between psychological treatments and cortical activity. Matching our current understanding of the content and goals of psychological pain treatments with knowledge regarding the primary cortical areas involved in the processing and experience of pain provides an initial step towards a neuropsychological model of pain. This model can be used to: (1) inform research and increase knowledge about the associations between cortical activity, pain treatment, and pain experience; (2) facilitate communication about psychological treatments with patients to facilitate treatment engagement; and (3) help guide the development of more effective treatment plans. In this way, the development, testing, and modification of a neuropsychological model of pain could result in more patients receiving more effective care. PERSPECTIVE A model that describes the effects of psychological treatments on specific pain-related cortical areas and processes could inform researchers who test hypotheses concerning the mechanisms of those treatments, and help pain clinicians develop more effective treatment plans.
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Affiliation(s)
- Mark P Jensen
- Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA 98195-6490, USA.
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Lumbar spinal stenosis: a brief review of the nonsurgical management. Can J Anaesth 2010; 57:694-703. [PMID: 20428988 DOI: 10.1007/s12630-010-9315-3] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2010] [Accepted: 04/12/2010] [Indexed: 10/19/2022] Open
Abstract
PURPOSE The purpose of this brief narrative review is to summarize the evidence derived from randomized controlled trials pertaining to the nonsurgical treatment of lumbar spinal stenosis (LSS). SOURCE The MEDLINE (January 1950 to the fourth week of January 2010) and EMBASE (January 1980 to 2009, week 53) databases, the MESH term "spinal stenosis", and the key words, "vertebral canal stenosis" and "neurogenic claudication", were searched. Results were limited to randomized controlled trials (RCTs) conducted on human subjects, written in English, and published in peer-reviewed journals. Only RCTs pertaining to nonsurgical treatment were considered. Studies comparing conservative and surgical management or different surgical techniques were not included in the review. PRINCIPAL FINDINGS The search criteria yielded 13 RCTs. The average enrolment was 54 subjects per study. Blinded assessment and sample size justification were provided in 85% and 39% of RCTs, respectively. The available evidence suggests that parenteral calcitonin, but not intranasal calcitonin, can transiently decrease pain in patients with LSS. In the setting of epidural blocks, local anesthetics can improve pain and function, but the benefits seem short-lived. The available evidence does not support the addition of steroids to local anesthetic agents. Based on the limited evidence, passive physical therapy seems to provide minimal benefits in LSS. The optimal regimen for active physiotherapy remains unknown. Although benefits have been reported with gabapentin, limaprost, methylcobalamin, and epidural adhesiolysis, further trials are required to validate these findings. CONCLUSIONS Because of their variable quality, published RCTs can provide only limited evidence to formulate recommendations pertaining to the nonsurgical treatment of LSS. In this narrative review, no study was excluded based on factors such as sample size justification, statistical power, blinding, definition of intervention allocation, or clinical outcomes. This aspect may represent a limitation as it may serve to overemphasize evidence derived from "weaker" trials. Further well-designed RCTs are warranted.
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Kim HY, Koo ST, Kim JH, An K, Chung K, Chung JM. Electroacupuncture analgesia in rat ankle sprain pain model: neural mechanisms. Neurol Res 2010; 32 Suppl 1:10-7. [PMID: 20034438 DOI: 10.1179/016164109x12537002793689] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVES Acupuncture, an alternative medical therapy with a long history, is appealing because it can activate endogenous analgesic mechanisms by minimally invasive means. The mechanisms of acupuncture, however, are not well understood yet. The following sentence was removed from our original manuscript. One of the major problems impeding understanding of the acupuncture mechanism is lack of experimental models that mimic various forms of persistent pain that respond to acupuncture in humans. METHODS In this review, we summarize and discuss previous and recent findings regarding electroacupuncture-induced analgesia in an ankle sprain pain model and the potential underlying mechanisms of acupuncture. RESULTS A novel model of ankle sprain pain is introduced recently and the mechanism of electroacupuncture-induced analgesia in this model has been explored. The following sentence was removed from our original manuscript. This model provides a reproducible and quantifiable index of persistent pain at the ankle joint in rats. Acupuncture at a remote site produces long-lasting and powerful analgesia. The consistent analgesic effect of acupuncture in this model has allowed us to pursue the underlying neural mechanisms. CONCLUSIONS These studies provide insight into the mechanisms of acupuncture analgesia in one particular form of persistent pain, and hopefully will allow us to expand our knowledge to other painful conditions.
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Affiliation(s)
- Hee Young Kim
- Department of Neuroscience and Cell Biology, University of Texas Medical Branch, Galveston, TX 77555-1069, USA
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118
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Fitzgibbon BM, Giummarra MJ, Georgiou-Karistianis N, Enticott PG, Bradshaw JL. Shared pain: From empathy to synaesthesia. Neurosci Biobehav Rev 2010; 34:500-12. [PMID: 19857517 DOI: 10.1016/j.neubiorev.2009.10.007] [Citation(s) in RCA: 88] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2009] [Revised: 08/26/2009] [Accepted: 10/17/2009] [Indexed: 12/30/2022]
Affiliation(s)
- Bernadette M Fitzgibbon
- Experimental Neuropsychology Research Unit, School of Psychology, Psychiatry and Psychological Medicine, Monash University, Clayton, Melbourne, Victoria 3800, Australia.
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119
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Effect of Roptrotherapy on Pressure-Pain Thresholds in Patients with Subacute Nonspecific Low Back Pain. ACTA ACUST UNITED AC 2010. [DOI: 10.1300/j094v15n01_06] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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120
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Overview of Chronic Post-thoracotomy Pain: Etiology and Treatment. Intensive Care Med 2010. [DOI: 10.1007/978-1-4419-5562-3_43] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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121
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Gelalis I, Arnaoutoglou E, Pakos E, Politis A, Rapti M, Xenakis T, Papadopoulos G. Effect of interlaminar epidural steroid injection in acute and subacute pain due to lumbar disk herniation: a randomized comparison of 2 different protocols. Open Orthop J 2009; 3:121-4. [PMID: 20111695 PMCID: PMC2812872 DOI: 10.2174/1874325000903010121] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2009] [Revised: 10/26/2009] [Accepted: 11/11/2009] [Indexed: 11/22/2022] Open
Abstract
In order to assess the efficacy of epidural steroid injections (ESI) in acute and subacute pain due to lumbar spine disk herniation, we conducted a randomized trial, comparing 2 different protocols. Fourty patients with radicular pain due to L4-L5 and L5-S1 disc herniation were assigned to receive either 3 consecutive ESI every 24 hours through a spinal catheter (group A) or 3 consecutive ESI every 10 days with an epidural needle (group B). All patients had improved Oswestry Disabilty Index (ODI) and the Visual Analog Scale (VAS) for pain scores at 1 month of follow-up compared to baseline, while no significant differences were observed between the 2 groups. The scores for group B were statistically significant lower at 2 months of follow-up compared to those of group A. The improvement in the scores of group B was continuous since the mean scores at 2 months of follow up were lower compared to the respective scores at 1 month. Protocol B (3 consecutive ESI every 10 days) was found more effective in the treatment of subacute pain compared to Protocol A (3 consecutive ESI every 24 hours) with statistically significant differences in the ODI and VAS scores at 2 months of follow-up.
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Affiliation(s)
- I.D Gelalis
- Department of Orthopaedic Surgery, University Hospital of Ioannina, University of Ioannina, School of Medicine, Ioannina, Greece
| | - E Arnaoutoglou
- Department of Anesthesiology, University Hospital of Ioannina, University of Ioannina, School of Medicine, Ioannina, Greece
| | - E.E Pakos
- Department of Orthopaedic Surgery, University Hospital of Ioannina, University of Ioannina, School of Medicine, Ioannina, Greece
| | - A.N Politis
- Department of Orthopaedic Surgery, University Hospital of Ioannina, University of Ioannina, School of Medicine, Ioannina, Greece
| | - M Rapti
- Department of Anesthesiology, University Hospital of Ioannina, University of Ioannina, School of Medicine, Ioannina, Greece
| | - T.A Xenakis
- Department of Orthopaedic Surgery, University Hospital of Ioannina, University of Ioannina, School of Medicine, Ioannina, Greece
| | - G Papadopoulos
- Department of Anesthesiology, University Hospital of Ioannina, University of Ioannina, School of Medicine, Ioannina, Greece
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Cathcart S. A neural hypothesis for stress-induced headache. Med Hypotheses 2009; 73:1011-3. [DOI: 10.1016/j.mehy.2009.03.056] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2009] [Revised: 03/11/2009] [Accepted: 03/12/2009] [Indexed: 11/25/2022]
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123
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MacMahon PJ, Eustace SJ, Kavanagh EC. Injectable corticosteroid and local anesthetic preparations: a review for radiologists. Radiology 2009; 252:647-61. [PMID: 19717750 DOI: 10.1148/radiol.2523081929] [Citation(s) in RCA: 146] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Corticosteroids and local anesthetics are some of the most commonly administered medications in radiology departments. These medications have marked variability in their formulations, which may increase their adverse event profile for specific procedures. In particular, certain corticosteroid preparations are associated with adverse central nervous system (CNS) sequelae. This is most likely due to distal embolization by particulate formulations. Nonparticulate steroid formulations are not associated with such events. Local anesthetics have severe CNS and cardiac adverse effects if injected intravascularly and have recently been associated with intraarticular chondrolysis if used in large doses. This review discusses these medications with particular emphasis on their established and postulated adverse effects. The administering radiologist should be aware of these potential effects and how best to reduce their occurrence.
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Affiliation(s)
- Peter J MacMahon
- Department of Radiology, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland.
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McAllister SL, McGinty KA, Resuehr D, Berkley KJ. Endometriosis-induced vaginal hyperalgesia in the rat: role of the ectopic growths and their innervation. Pain 2009; 147:255-64. [PMID: 19819623 DOI: 10.1016/j.pain.2009.09.022] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2009] [Revised: 08/19/2009] [Accepted: 09/21/2009] [Indexed: 12/27/2022]
Abstract
Endometriosis is a painful disorder defined by extrauteral endometrial growths whose contribution to pain symptoms is poorly understood. Endometriosis is created in rats by autotransplanting on abdominal arteries pieces of either uterus (ENDO), which form cysts, or fat (shamENDO), which do not form cysts. ENDO, but not shamENDO induces vaginal hyperalgesia. We tested the hypothesis that the cysts are necessary to maintain vaginal hyperalgesia by assessing the effect of surgically removing them. Complete-cyst-removal eliminated ENDO-induced vaginal hyperalgesia up to 4 months post-operatively. Sham-cyst-removal in ENDO rats, in which cysts were not removed, or partial cyst-removal increased the ENDO-induced hyperalgesia. The decreases and increases both took 3-6 weeks to develop. Changes in ENDO-induced hyperalgesia did not occur in a control group of ENDO rats who had no surgery after ENDO. In a double-surgery control group, neither shamENDO surgery nor a subsequent sham surgery that mimicked "removal" of non-existent cysts influenced vaginal nociception. In a no-surgery control group, vaginal nociception remained stable for >6 months. The increases in ENDO-induced hyperalgesia produced by the sham-cyst-removal surgery were smaller in proestrus than in other estrous stages. During the other stages (but not during proestrus), sympathetic innervation of the cysts increased. These results suggest that maintenance of ENDO-induced vaginal hyperalgesia requires continued presence of at least some ectopic endometrial tissue, and that surgical treatment that fails to remove ectopic endometrial tissue can exacerbate the hyperalgesia, possibly due in part to an increase in the cysts' sympathetic innervation.
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Affiliation(s)
- Stacy L McAllister
- Program in Neuroscience, Florida State University, Tallahassee, FL 32306-4301, USA
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125
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Abstract
Chronic pelvic pain affects both men and women; there are probably common mechanisms that involve the central nervous system. In many cases, the symptoms may be localised to a single end organ. However, the involvement of the central nervous system may result in a complex regional pain syndrome affecting the whole pelvis and as a consequence, multiple-organ symptomatology. The initial trigger may be relatively benign but a predisposed individual may develop a range of significant sensory and efferent functional abnormalities. Stimuli not normally reaching threshold may be perceived and normal sensations may be magnified to become dysphoric or painful. Problems of emptying viscera and maintaining continence may occur. Significant musculoskeletal disability may arise as well as abnormalities of the autonomic nervous system. There is an association with systemic disorders. Also, psychological, behavioural, sexual and social problems arise. In the chronic pelvic pain syndromes, treatment of the end organ has a limited role, and multidisciplinary as well as interdisciplinary management is essential.
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126
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Jensen MP, Barber J, Romano JM, Hanley MA, Raichle KA, Molton IR, Engel JM, Osborne TL, Stoelb BL, Cardenas DD, Patterson DR. Effects of self-hypnosis training and EMG biofeedback relaxation training on chronic pain in persons with spinal-cord injury. Int J Clin Exp Hypn 2009; 57:239-68. [PMID: 19459087 PMCID: PMC2730649 DOI: 10.1080/00207140902881007] [Citation(s) in RCA: 78] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Thirty-seven adults with spinal-cord injury and chronic pain were randomly assigned to receive 10 sessions of self-hypnosis (HYP) or EMG biofeedback relaxation (BIO) training for pain management. Participants in both treatment conditions reported substantial, but similar, decreases in pain intensity from before to after the treatment sessions. However, participants in the HYP condition, but not the BIO condition, reported statistically significant decreases in daily average pain pre- to posttreatment. These pre- to posttreatment decreases in pain reported by the HYP participants were maintained at 3-month follow-up. Participants in the HYP condition, but not the BIO condition, also reported significant pre- to posttreatment increases in perceived control over pain, but this change was not maintained at the 3-month follow-up.
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Affiliation(s)
- Mark P Jensen
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington 98195-6490, USA
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127
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Cuadros J, Vargas M. A new mind-body approach for a total healing of fibromyalgia: a case report. AMERICAN JOURNAL OF CLINICAL HYPNOSIS 2009; 52:3-12. [PMID: 19678555 DOI: 10.1080/00029157.2009.10401687] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Fibromyalgia is a severe, chronic and widespread pain syndrome with no definite treatment protocol. Several medications are currently in use to treat this condition. Various pharmacological treatments, as well as alternative mind-body therapies, have been directed towards reducing fatigue and pain, but these treatments have only resulted in a partial relief of symptoms with no long-term or permanent effects. This study shows the results obtained from four female patients suffering from fibromyalgia after undergoing a mind-body treatment in which psychosocial genomic postulates as well as ideodynamic hand movements were the main tools employed in their healing. It is suggested that a mind-body oriented treatment could generate stable and permanent changes that enable patients to experience a total recovery from fibromyalgia.
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128
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Stokvis A, Coert JH, van Neck JW. Insufficient pain relief after surgical neuroma treatment: Prognostic factors and central sensitisation. J Plast Reconstr Aesthet Surg 2009; 63:1538-43. [PMID: 19559663 DOI: 10.1016/j.bjps.2009.05.036] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2009] [Revised: 04/21/2009] [Accepted: 05/18/2009] [Indexed: 11/18/2022]
Abstract
BACKGROUND Treatment of patients with neuromatous pain is difficult. Numerous treatment methods have been described, but none has been completely effective in providing sufficient pain relief. Patient-specific prognostic factors, predicting pain after surgical neuroma treatment, can help clinicians in the process of patient treatment and care. METHODS A computerised bibliographical database (PubMed Medline) was searched for articles concerning prognostic factors predicting the outcome of surgical neuroma treatment, and all the reference lists were checked. RESULTS Evidence for predicting the outcome was found for neuromas of the radial sensory branch and digital nerves, discrete nerve syndrome, workers compensation, employment status, litigation involvement, duration of pain and number of previous operations. Psychosocial problems are often found in neuroma patients. In chronic neuropathic pain patients, changes in the central nervous system at the level of spinal cord and in the somatosensory cortex can be found. CONCLUSIONS Neuromas of the radial sensory branch and digital nerves, discrete nerve syndrome, workers' compensation, employment status, litigation involvement, duration of pain and number of previous operations appear to predict the amount of pain after neuroma surgery. However, in a minority of patients, a bad outcome cannot be explained by these factors; in these patients, central sensitisation and psychosocial factors may play a role in maintaining pain. Research focussing on prognostic factors and the central changes induced by painful peripheral injury can lead to new and improved clinical treatment algorithms for the relief and prevention of chronic neuropathic pain.
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Affiliation(s)
- Annemieke Stokvis
- Department of Plastic and Reconstructive Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
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129
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From pleasure to pain: The role of the MPQ in the language of phantom limb pain. Soc Sci Med 2009; 69:655-61. [PMID: 19299060 DOI: 10.1016/j.socscimed.2009.02.022] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2008] [Indexed: 11/20/2022]
Abstract
In opposition to the argument that pain is private, personal and unsharable, I propose that the intersubjectivity of pain is fundamental to it. Using the case of phantom limb, I show how a specific language of pain emerged and became concretized in the US circa 1975 with the advent of the McGill Pain Questionnaire (MPQ). Through widespread use of the MPQ, a language of pain materialized, one that was commonly used to describe the qualitative dimensions of phantom limb. After 1975, the terminology used within the medical literature was overwhelmingly consonant with the set of descriptors advanced by the MPQ. The utilization of a pain questionnaire to assess the qualitative dimensions of phantom limb effectively accentuated pain, and by 1980, what was once considered relatively rare became a common sequela of phantom manifestation.
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130
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Navarro X. Chapter 27: Neural plasticity after nerve injury and regeneration. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2009; 87:483-505. [PMID: 19682656 DOI: 10.1016/s0074-7742(09)87027-x] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Injuries to the peripheral nerves result in partial or total loss of motor, sensory, and autonomic functions in the denervated segments of the body due to the interruption of axons, degeneration of distal nerve fibers, and eventual death of axotomized neurons. Functional deficits caused by nerve injuries can be compensated by reinnervation of denervated targets by regenerating injured axons or by collateral branching of undamaged axons, and remodeling of nervous system circuitry related to the lost functions. Plasticity of central connections may compensate functionally for the lack of adequate target reinnervation; however, plasticity has limited effects on disturbed sensory localization or fine motor control after injuries, and may even result in maladaptive changes, such as neuropathic pain and hyperreflexia. After axotomy, neurons shift from a transmitter to a regenerative phenotype, activating molecular pathways that promote neuronal survival and axonal regeneration. Peripheral nerve injuries also induce a cascade of events, at the molecular, cellular, and system levels, initiated by the injury and progressing throughout plastic changes at the spinal cord, brainstem nuclei, thalamus, and brain cortex. Mechanisms involved in these changes include neurochemical changes, functional alterations of excitatory and inhibitory synaptic connections, sprouting of new connections, and reorganization of sensory and motor central maps. An important direction for research is the development of therapeutic strategies that enhance axonal regeneration, promote selective target reinnervation, and are also able to modulate central nervous system reorganization, amplifying positive adaptive changes that improve functional recovery and also reducing undesirable effects.
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Affiliation(s)
- Xavier Navarro
- Institute of Neurosciences and Department of Cell Biology, Physiology and Immunology, Universitat Autònoma de Barcelona, E-08193 Bellaterra, Spain
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131
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Chung KF, Widdicombe J. Peripheral mechanisms II: the pharmacology of peripherally active antitussive drugs. Handb Exp Pharmacol 2009; 187:155-86. [PMID: 18825340 PMCID: PMC7122788 DOI: 10.1007/978-3-540-79842-2_8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Cough is an indispensable defensive reflex. Although generally beneficial, it is also a common symptom of diseases such as asthma, chronic obstructive pulmonary disease, upper respiratory tract infections, idiopathic pulmonary fibrosis and lung cancer. Cough remains a major unmet medical need and although the centrally acting opioids have remained the antitussive of choice for decades, they have many unwanted side effects. However, new research into the behaviour of airway sensory nerves has provided greater insight into the mechanisms of cough and new avenues for the discovery of novel non-opioid antitussive drugs. In this review, the pathophysiological mechanisms of cough and the development of novel antitussive drugs are reviewed.
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Affiliation(s)
- Kian Fan Chung
- National Heart & Lung Institute, Imperial College, Dovehouse Street, London, SW3 6LY UK
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132
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Effects of spinal anaesthesia versus epidural anaesthesia for caesarean section on postoperative analgesic consumption and postoperative pain. Eur J Anaesthesiol 2009; 26:52-9. [DOI: 10.1097/eja.0b013e328318c639] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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133
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Abstract
Chronic back pain is among the most common patient complaints. Its prevalence and impact have spawned a rapidly expanding range of tests and treatments. Some of these have become widely used for indications that are not well validated, leading to uncertainty about efficacy and safety, increasing complication rates, and marketing abuses. Recent studies document a 629% increase in Medicare expenditures for epidural steroid injections; a 423% increase in expenditures for opioids for back pain; a 307% increase in the number of lumbar magnetic resonance images among Medicare beneficiaries; and a 220% increase in spinal fusion surgery rates. The limited studies available suggest that these increases have not been accompanied by population-level improvements in patient outcomes or disability rates. We suggest a need for a better understanding of the basic science of pain mechanisms, more rigorous and independent trials of many treatments, a stronger regulatory stance toward approval and post-marketing surveillance of new drugs and devices for chronic pain, and a chronic disease model for managing chronic back pain.
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134
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Ene KW, Nordberg G, Sjöström B, Bergh I. Prediction of postoperative pain after radical prostatectomy. BMC Nurs 2008; 7:14. [PMID: 19068111 PMCID: PMC2635357 DOI: 10.1186/1472-6955-7-14] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2008] [Accepted: 12/09/2008] [Indexed: 12/03/2022] Open
Abstract
Background There is a belief that the amount of pain perceived is merely directly proportional to the extent of injury. The intensity of postoperative pain is however influenced by multiple factors aside from the extent of trauma. The purpose of the study was to evaluate the relationship between preoperative factors that have been shown to predict postoperative pain and the self-reports of pain intensity in a population of 155 men undergoing radical prostatectomy (RP), and also to investigate if previous pain score could predict the subsequent pain score. Methods The correlation between potential pain predictors and the postoperative pain experiences during three postoperative days was tested (Pitmans' test). By use of a logistic regression analysis the probability that a Visual Analogue Scale (VAS) score at one occasion would exceed 30 mm or 70 mm was studied, depending on previous VAS score, age, depression and pain treatment method. Results Age was found to be a predictor of VAS > 30 mm, with younger patients at higher risk for pain, and preoperative depression predicted VAS > 70 mm. The probability that VAS would exceed 30 mm and 70 mm was predicted only by previous VAS value. Day two however, patients with epidural analgesia were at higher risk for experiencing pain than patients with intrathecal or systemic opioid analgesia. Conclusion The results show that it would be meaningful to identify RP patients at high risk for severe postoperative pain; i.e. younger and/or depressive patients who might benefit from a more aggressive therapy instituted in the very early postoperative period.
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Affiliation(s)
- Kerstin Wickström Ene
- The Sahlgrenska Acedemy at Göteborg University, Institute of Health and Care Sciences, Gothenburg, Sweden.
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135
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Quante M, Hille S, Schofer MD, Lorenz J, Hauck M. Noxious counterirritation in patients with advanced osteoarthritis of the knee reduces MCC but not SII pain generators: A combined use of MEG and EEG. J Pain Res 2008; 1:1-8. [PMID: 21197282 PMCID: PMC3004616 DOI: 10.2147/jpr.s3996] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Chronic pain is mainly a result of two processes: peripheral and central sensitization, which can result in neuroplastic changes. Previous psychophysical studies suggested a decrease of the so-called pain-inhibiting-pain effect (DNIC) in chronic pain patients. We aimed to study the DNIC effect on the neuronal level using magnetoencephalography and electroencephalography in 12 patients suffering from advanced unilateral knee osteoarthritis (OA). DNIC was induced in patients by provoking the typical OA pain by a slightly hyperextended joint position, while they received short electrical pain stimuli. Although the patients did not report a reduction of electrical pain perception, the cingulate gyrus showed a decrease of activation during provoked OA pain, while activity in the secondary somatosensory cortex did not change. Based on much stronger DNIC induction at comparable intensities of an acute counterirritant pain in healthy subjects this result suggests a deficit of DNIC in OA patients. We suggest that the strength of DNIC is subject to neuronal plasticity of descending inhibitory pain systems and diminishes during the development of a chronic pain condition.
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Affiliation(s)
- Markus Quante
- Specialist Centre for Spinal Surgery, Hospital Neustadt, Neustadt in Holstein, Germany
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136
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Lam D, Sessle B, Hu J. Surgical incision can alter capsaicin-induced central sensitization in rat brainstem nociceptive neurons. Neuroscience 2008; 156:737-47. [DOI: 10.1016/j.neuroscience.2008.07.058] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2008] [Revised: 07/15/2008] [Accepted: 07/30/2008] [Indexed: 11/30/2022]
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137
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Jensen MP. The neurophysiology of pain perception and hypnotic analgesia: implications for clinical practice. AMERICAN JOURNAL OF CLINICAL HYPNOSIS 2008; 51:123-48. [PMID: 18998379 DOI: 10.1080/00029157.2008.10401654] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Although there remains much to be learned, a great deal is now known about the neurophysiological processes involved in the experience of pain. Research confirms that there is no single focal "center" in the brain responsible for the experience of pain. Rather, pain is the end product of a number of integrated networks that involve activity at multiple cortical and subcortical sites. Our current knowledge about the neurophysiological mechanisms of pain has important implications for understanding the mechanisms underlying the effects of hypnotic analgesia treatments, as well as for improving clinical practice. This article is written for the clinician who uses hypnotic interventions for pain management. It begins with an overview of what is known about the neurophysiological basis of pain and hypnotic analgesia, and then discusses how clinicians can use this knowledge for (1) organizing the types of suggestions that can be used when providing hypnotic treatment, and (2) maximizing the efficacy of hypnotic interventions in clients presenting with pain problems.
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138
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Cervical medial branch blocks for chronic cervical facet joint pain: a randomized, double-blind, controlled trial with one-year follow-up. Spine (Phila Pa 1976) 2008; 33:1813-20. [PMID: 18670333 DOI: 10.1097/brs.0b013e31817b8f88] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A double-blind, randomized, controlled trial. OBJECTIVE To determine the clinical effectiveness of therapeutic local anesthetic cervical medial branch blocks with or without steroid in managing chronic neck pain of facet joint origin. SUMMARY OF BACKGROUND DATA The prevalence of persistent neck pain, secondary to involvement of cervical facet or zygapophysial joints, has been described in controlled studies as varying from 39% to 67%. Intra-articular injections, medial branch nerve blocks, and neurolysis of medial branch nerves have been described in managing chronic neck pain of facet joint origin. METHODS A total of 120 patients were included, with 60 patients in each of the local anesthetic and steroid groups. All the patients met the diagnostic criteria of cervical facet joint pain by means of comparative, controlled diagnostic blocks, and the inclusion criteria. Group I consisted of medial branch blocks with bupivacaine. Group II consisted of cervical medial branch blocks with bupivacaine and steroid. Numerical pain scores, Neck Disability Index, opioid intake, and work status were evaluated at baseline, 3 months, 6 months, and 12 months. RESULTS Significant pain relief (>or=50%) and functional status improvement was observed at 3 months, 6 months, and 12 months in over 83% of patients. The average number of treatments for 1 year was 3.5 +/- 1.0 in the nonsteroid group and 3.4 +/- 0.9 in the steroid group. Duration of average pain relief with each procedure was 14 +/- 6.9 weeks in the nonsteroid group, and it was 16 +/- 7.9 weeks in the steroid group. Significant relief and functional improvement was reported for 46 to 48 weeks in a year. CONCLUSION Therapeutic cervical medial branch nerve blocks, with or without steroids, may provide effective management for chronic neck pain of facet joint origin.
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139
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Teutsch S, Herken W, Bingel U, Schoell E, May A. Changes in brain gray matter due to repetitive painful stimulation. Neuroimage 2008; 42:845-9. [PMID: 18582579 DOI: 10.1016/j.neuroimage.2008.05.044] [Citation(s) in RCA: 151] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2008] [Revised: 04/24/2008] [Accepted: 05/14/2008] [Indexed: 01/11/2023] Open
Abstract
Using functional imaging, we recently investigated how repeated painful stimulation over several days is processed, perceived and modulated in the healthy human brain. Considering that activation-dependent brain plasticity in humans on a structural level has already been demonstrated in adults, we were interested in whether repeated painful stimulation may lead to structural changes of the brain. 14 healthy subjects were stimulated daily with a 20 min pain paradigm for 8 consecutive days, using structural MRI performed on days 1, 8, 22 and again after 1 year. Using voxel based morphometry, we are able to show that repeated painful stimulation resulted in a substantial increase of gray matter in pain transmitting areas, including mid-cingulate and somatosensory cortex. These changes are stimulation dependent, i.e. they recede after the regular nociceptive input is stopped. This data raises some interesting questions regarding structural plasticity of the brain concerning the experience of both acute and chronic pain.
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Affiliation(s)
- S Teutsch
- Department of Systems Neuroscience, University of Hamburg (UKE), D-20246 Hamburg, Germany
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140
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Phillips C, Main C, Buck R, Aylward M, Wynne-Jones G, Farr A. Prioritising pain in policy making: the need for a whole systems perspective. Health Policy 2008; 88:166-75. [PMID: 18455259 DOI: 10.1016/j.healthpol.2008.03.008] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2007] [Revised: 03/10/2008] [Accepted: 03/16/2008] [Indexed: 11/26/2022]
Abstract
This review aims to bring together current evidence on the impact of chronic pain in terms of its economic costs, cost to healthcare services and benefit agencies, and quality of life, and to discuss the implications of this for government policies. Quantifying the burden and cost of pain is challenging due to its multi-factorial nature and wide reaching effects. Nonetheless, there is a consensus that chronic pain has a significant impact on levels of resources across society and on quality of life. Pain is a complex bio-psychosocial experience and chronic pain is a consequence, in part, of adopting a narrow biomedical treatment approach to a problem which requires a multi-disciplinary approach to address the psychosocial, behavioural and biomedical aspects of pain. Although effective pain management interventions and programmes exist, provision of these services is inconsistent, and chronic pain is not given the priority it requires in view of the extent of its burden on individuals and society. Current relevant government policies in U.K. are discussed to highlight the need to prioritise pain and adopt a whole-systems approach to its management if governments are to successfully reduce its cost and burden.
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Affiliation(s)
- Ceri Phillips
- Institute for Health Research, School of Health Science, Swansea University, Singleton Park, Swansea, SA2 8PP Wales, UK.
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141
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Enohumah KO, Imarengiaye CO. Pain in osteoarthritis: A review of literature. SOUTHERN AFRICAN JOURNAL OF ANAESTHESIA AND ANALGESIA 2008. [DOI: 10.1080/22201173.2008.10872552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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142
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May A. Chronic pain may change the structure of the brain. Pain 2008; 137:7-15. [PMID: 18410991 DOI: 10.1016/j.pain.2008.02.034] [Citation(s) in RCA: 448] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2007] [Revised: 02/21/2008] [Accepted: 02/27/2008] [Indexed: 11/30/2022]
Abstract
Recently, local morphologic alterations of the brain in areas ascribable to the transmission of pain were detected in patients suffering from phantom pain, chronic back pain, irritable bowl syndrome, fibromyalgia and two types of frequent headaches. These alterations were different for each pain syndrome, but overlapped in the cingulate cortex, the orbitofrontal cortex, the insula and dorsal pons. These regions function as multi-integrative structures during the experience and the anticipation of pain. As it seems that chronic pain patients have a common "brain signature" in areas known to be involved in pain regulation, the question arises whether these changes are the cause or the consequence of chronic pain. The author suggests that the gray matter change observed in chronic pain patients are the consequence of frequent nociceptive input and should thus be reversible when pain is adequately treated.
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Affiliation(s)
- Arne May
- Department of Systems Neuroscience, University of Hamburg Eppendorf (UKE), Martinistrasse 52, D-20246 Hamburg, Germany
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143
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Wilson JA, Nimmo AF, Fleetwood-Walker SM, Colvin LA. A randomised double blind trial of the effect of pre-emptive epidural ketamine on persistent pain after lower limb amputation. Pain 2008; 135:108-18. [PMID: 17583431 DOI: 10.1016/j.pain.2007.05.011] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2006] [Revised: 05/09/2007] [Accepted: 05/14/2007] [Indexed: 01/19/2023]
Abstract
Persistent pain has been reported in up to 80% of patients after limb amputation. The mechanisms are not fully understood, but nerve injury during amputation is important, with evidence for the crucial involvement of the spinal N-methyl d-aspartate (NMDA) receptor in central changes. The study objective was to assess the effect of pre-emptively modulating sensory input with epidural ketamine (an NMDA antagonist) on post-amputation pain and sensory processing. The study recruited 53 patients undergoing lower limb amputation who received a combined intrathecal/epidural anaesthetic for surgery followed by a randomised epidural infusion (Group K received racemic ketamine and bupivacaine; Group S received saline and bupivacaine). Neither general anaesthesia nor opioids were used during the peri-operative period. Pain characteristics were assessed for 12 months. The primary endpoint was incidence and severity of post-amputation pain. Persistent pain at one year was much less in both groups than in comparable studies, with no significant difference between groups (Group K=21% (3/14) and 50% (7/14); and Group S=33% (5/15) and 40% (6/15) for stump and phantom pain, respectively). Post-operative analgesia was significantly better in Group K, with reduced stump sensitivity. The intrathecal/epidural technique used, with peri-operative sensory attenuation, may have reduced ongoing sensitisation, reducing the overall incidence of persistent pain. The improved short-term analgesia and reduced mechanical sensitivity in Group K may reflect acute effects of ketamine on central sensitisation. Longer term effects on mood were detected in Group K that requires further study.
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Affiliation(s)
- John A Wilson
- Department of Anaesthesia Critical Care and Pain Medicine, Clinical and Surgical Sciences, The University of Edinburgh, Royal Infirmary, Little France, Edinburgh EH16 4SA, UK
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144
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New insights into neuromodulatory approaches for the treatment of pain. THE JOURNAL OF PAIN 2007; 9:193-9. [PMID: 18096437 DOI: 10.1016/j.jpain.2007.11.003] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 07/11/2007] [Revised: 10/23/2007] [Accepted: 11/01/2007] [Indexed: 11/22/2022]
Abstract
UNLABELLED Two lines of evidence about the association between the experience of pain and brain state (measured via electroencephalogram or EEG) have recently come to light. First, research from a number of sources suggests a link between brain EEG activity and the experience of pain. Specifically, this research suggests that the subjective experience of pain is associated with relatively lower amplitudes of slower wave (delta, theta, and alpha) activity and relatively higher amplitudes of faster wave (beta) activity. Second, there has been a recent increase in interest in interventions that impact the cortical neuromodulation of pain, including behavioral treatments (such as self-hypnosis training and neurofeedback) and both invasive and noninvasive brain stimulation. Although a direct causal link between experience of pain and brain activity as measured by EEG has not been established, the targeting of pain treatment at a cortical level by trying to affect EEG rhythms directly is an intriguing possibility. PERSPECTIVE Preliminary evidence suggests the possibility, which has not yet adequately tested or proven, that the experience of chronic pain is linked to cortical activity as assessed via an electroencephalogram. Support for this hypothesis would have important implications for understanding the mechanisms that underlie a number of pain treatments, and for developing new innovative treatments for chronic pain management.
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Pasqualucci A, Varrassi G, Braschi A, Peduto VA, Brunelli A, Marinangeli F, Gori F, Colò F, Paladini A, Mojoli F. Epidural local anesthetic plus corticosteroid for the treatment of cervical brachial radicular pain: single injection versus continuous infusion. Clin J Pain 2007; 23:551-7. [PMID: 17710003 DOI: 10.1097/ajp.0b013e318074c95c] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Efficacy of epidural local anesthetics plus steroids for the treatment of cervicobrachial pain is uncertain. METHODS A prospective study randomized 160 patients with cervicobrachial pain resistant to conventional therapy. Patients were divided into 4 groups on the basis of the time between pain onset and treatment initiation: group A, 40 patients with pain onset 15 to 30 days; group B, 40 patients with pain from 31 to 60 days; group C, 40 patients, 61 to 180 days; and group D, 40 patients with pain >180 days. Patients of each group were randomized to receive an epidural block with bupivacaine and methylprednisolone at intervals of 4 to 5 days (Single injection) or continuous epidural bupivacaine every 6, 12, or 24 hours plus methylprednisolone every 4 to 5 days (Continuos epidural). The maximum duration of treatment (9 blocks in Single injection, and 30 days in Continuos epidural) was dependent on achieving Pain Control (PC) > or =80% [PC is defined by this formulae: (100) (VAS(initial)-VAS(final))/VAS(initial)]. Follow-up at 1 month and 6 months compared PC and the number of pain-free hours of sleep. RESULTS One hundred forty-one patients completed the study. The 4 groups had similar characteristics. At the 1-month and 6-month follow-up analysis based on the time between pain onset and treatment initiation showed that patients of group D, who received the Continuous epidural treatment, had significantly greater PC and significantly more pain-free hours of sleep compared with similar patients in Single injection. CONCLUSIONS Therapy with continuous epidural local anesthetic and methylprednisolone provides better control of chronic cervicobrachial pain compared with Single injection. These results are discussed with respect to the possible mechanism of action of the drugs and may relate to the physiopathologic mechanisms associated with neuronal plasticity that result in chronic pain.
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Affiliation(s)
- Alberto Pasqualucci
- Department of Anesthesiology and Intensive Care, University of Perugia, Italy.
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146
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Sarchielli P, Di Filippo M, Nardi K, Calabresi P. Sensitization, glutamate, and the link between migraine and fibromyalgia. Curr Pain Headache Rep 2007; 11:343-51. [PMID: 17894924 DOI: 10.1007/s11916-007-0216-2] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Recent advances have shed insight on the pathophysiologic mechanisms of fibromyalgia and migraine, especially in the chronic form. A growing body of evidence supports the involvement of peripheral and central sensitization disturbances of pain-related processes underlying both disorders. They involve increased glutamate transmission through interaction with its ionotropic and metabotropic receptors. Few studies supporting the implication of this excitatory amino acid in chronic migraine and primary fibromyalgia demonstrated increased levels of glutamate in the cerebrospinal fluid of affected patients. These findings have implications for future therapies directed against glutamate receptors (in particular, N-methyl-D-aspartate receptors). Limited clinical experience in this regard, although promising, does not exclude additional mechanisms contributing to the maintenance of pain, which can be the target of therapeutic approaches in both disorders.
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Affiliation(s)
- Paola Sarchielli
- Neurologic Clinic, Department of Medical and Surgical Specialties and Public Health, University of Perugia, Ospedale Santa Maria della Misericordia, Via Santa Andrea delle Fratte, San Sisto, 06158 Perugia, Italy.
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147
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Vanotti A, Osio M, Mailland E, Nascimbene C, Capiluppi E, Mariani C. Overview on pathophysiology and newer approaches to treatment of peripheral neuropathies. CNS Drugs 2007; 21 Suppl 1:3-12; discussion 45-6. [PMID: 17696588 DOI: 10.2165/00023210-200721001-00002] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Peripheral neuropathies are extremely heterogeneous nosological entities. One of the most common symptoms is pain, the underlying mechanisms of which are numerous and complex. Inflammation, reparative processes, and anatomical and gene expression alterations lead to chronic pain, the persistence of which is sustained by peripheral and central sensitisation mechanisms. Treatment of peripheral neuropathies is targeted to its symptomatic and aetiological features. For pain relief, several types of drugs may be used, notably antidepressants (e.g. tricyclic antidepressants, selective serotonin reuptake inhibitors, and both serotonin and noradrenaline [norepinephrine] reuptake inhibitors), antiepileptic drugs (e.g. carbamazepine, phenytoin, lamotrigine, valproic acid, gabapentin, topiramate and pregabalin), NSAIDs and opioid analgesics. Aetiological therapy is aimed at modifying the pathophysiological mechanisms underlying the neuropathy, some of which are common in different neuropathic conditions. Certain drugs are known to exert more than one action on different pathophysiological mechanisms. This is the case with acetyl-L-carnitine (ALC), which can be considered both a symptomatic therapy that can be used in any kind of painful neuropathy, and an aetiological therapy, at least in diabetic neuropathy and neuropathies induced by nucleoside reverse transcriptase inhibitors and cancer chemotherapeutic agents. ALC acts via several mechanisms, inducing regeneration of injured nerve fibres, reducing oxidative stress, supporting DNA synthesis in mitochondria, and enhancing nerve growth factor concentrations in neurons.
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148
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Lohmander LS, Englund PM, Dahl LL, Roos EM. The long-term consequence of anterior cruciate ligament and meniscus injuries: osteoarthritis. Am J Sports Med 2007; 35:1756-69. [PMID: 17761605 DOI: 10.1177/0363546507307396] [Citation(s) in RCA: 1513] [Impact Index Per Article: 89.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The objectives of this study are to review the long-term consequences of injuries to the anterior cruciate ligament and menisci, the pathogenic mechanisms, and the causes of the considerable variability in outcome. Injuries of the anterior cruciate ligament and menisci are common in both athletes and the general population. At 10 to 20 years after the diagnosis, on average, 50% of those with a diagnosed anterior cruciate ligament or meniscus tear have osteoarthritis with associated pain and functional impairment: the young patient with an old knee. These individuals make up a substantial proportion of the overall osteoarthritis population. There is a lack of evidence to support a protective role of repair or reconstructive surgery of the anterior cruciate ligament or meniscus against osteoarthritis development. A consistent finding in a review of the literature is the often poor reporting of critical study variables, precluding data pooling or a meta-analysis. Osteoarthritis development in the injured joints is caused by intra-articular pathogenic processes initiated at the time of injury, combined with long-term changes in dynamic joint loading. Variation in outcome is reinforced by additional variables associated with the individual such as age, sex, genetics, obesity, muscle strength, activity, and reinjury. A better understanding of these variables may improve future prevention and treatment strategies. In evaluating medical treatment, we now expect large randomized clinical trials complemented by postmarketing monitoring. We should strive toward a comparable level of quality of evidence in surgical treatment of knee injuries. In instances in which a randomized clinical trial is not feasible, natural history and other observational cohort studies need to be as carefully designed and reported as the classic randomized clinical trial, to yield useful information.
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Affiliation(s)
- L Stefan Lohmander
- Department of Orthopaedics, Clinical Sciences Lund, Lund University, Lund, Sweden.
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149
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Moseley LG. Using visual illusion to reduce at-level neuropathic pain in paraplegia. Pain 2007; 130:294-298. [PMID: 17335974 DOI: 10.1016/j.pain.2007.01.007] [Citation(s) in RCA: 103] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2006] [Revised: 01/04/2007] [Accepted: 01/10/2007] [Indexed: 11/28/2022]
Abstract
Neuropathic pain after spinal cord injury is not well understood and is difficult to treat. One possible cause is mismatch between motor commands and sensory feedback. This two-part study in five paraplegic patients investigated whether a visual illusion aimed to correct this mismatch reduces pain. In study 1, patients undertook three conditions: (i) virtual walking: with a mirror placed in front of a screen, patients aligned their own upper body with a film of a lower body walking. Patients imagined walking and 'watched themselves' walk; (ii) guided imagery; (iii) watching a film. One patient withdrew from virtual walking because of distress. For all patients, the mean (95% CI) decrease in pain (100 mm VAS) was 42 mm (approximately 65%) (11-73 mm) for virtual walking, 18 mm (4-31 mm) for guided imagery and 4mm (-3 to 11 mm) for watching the film. Mean (95% CI) time to return to pre-task pain was 34.9 min (20.1-49.8 min) for virtual walking; 13.9 min (-0.9 to 28.8 min) for the guided imagery and 16.3 min (1.5-31.2 min) for the film. To investigate its clinical utility, four patients underwent virtual walking every weekday for 3 weeks. Mean (95% CI) decrease in pain was 53 mm (45-61 mm) at post training and 43 mm (27-58 mm) at 3-month follow-up. Virtual walking may be a viable treatment for pain after spinal cord injury. A clinical trial seems warranted.
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Affiliation(s)
- Lorimer G Moseley
- Department of Physiology, Anatomy and Genetics and fMRIB Centre, University of Oxford, Le Gros Clark Building, South Parks Road, Oxford OX1 3QX, United Kingdom
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150
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Navarro X, Vivó M, Valero-Cabré A. Neural plasticity after peripheral nerve injury and regeneration. Prog Neurobiol 2007; 82:163-201. [PMID: 17643733 DOI: 10.1016/j.pneurobio.2007.06.005] [Citation(s) in RCA: 619] [Impact Index Per Article: 36.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2006] [Revised: 02/18/2007] [Accepted: 06/14/2007] [Indexed: 01/01/2023]
Abstract
Injuries to the peripheral nerves result in partial or total loss of motor, sensory and autonomic functions conveyed by the lesioned nerves to the denervated segments of the body, due to the interruption of axons continuity, degeneration of nerve fibers distal to the lesion and eventual death of axotomized neurons. Injuries to the peripheral nervous system may thus result in considerable disability. After axotomy, neuronal phenotype switches from a transmitter to a regenerative state, inducing the down- and up-regulation of numerous cellular components as well as the synthesis de novo of some molecules normally not expressed in adult neurons. These changes in gene expression activate and regulate the pathways responsible for neuronal survival and axonal regeneration. Functional deficits caused by nerve injuries can be compensated by three neural mechanisms: the reinnervation of denervated targets by regeneration of injured axons, the reinnervation by collateral branching of undamaged axons, and the remodeling of nervous system circuitry related to the lost functions. Plasticity of central connections may compensate functionally for the lack of specificity in target reinnervation; plasticity in human has, however, limited effects on disturbed sensory localization or fine motor control after injuries, and may even result in maladaptive changes, such as neuropathic pain, hyperreflexia and dystonia. Recent research has uncovered that peripheral nerve injuries induce a concurrent cascade of events, at the systemic, cellular and molecular levels, initiated by the nerve injury and progressing throughout plastic changes at the spinal cord, brainstem relay nuclei, thalamus and brain cortex. Mechanisms for these changes are ubiquitous in central substrates and include neurochemical changes, functional alterations of excitatory and inhibitory connections, atrophy and degeneration of normal substrates, sprouting of new connections, and reorganization of somatosensory and motor maps. An important direction for ongoing research is the development of therapeutic strategies that enhance axonal regeneration, promote selective target reinnervation, but are also able to modulate central nervous system reorganization, amplifying those positive adaptive changes that help to improve functional recovery but also diminishing undesirable consequences.
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Affiliation(s)
- X Navarro
- Group of Neuroplasticity and Regeneration, Institute of Neurosciences and Department of Cell Biology, Physiology and Immunology, Universitat Autònoma de Barcelona, E-08193 Bellaterra, Spain.
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