1
|
Beating Pain with Psychedelics: Matter over Mind? Neurosci Biobehav Rev 2021; 134:104482. [PMID: 34922987 DOI: 10.1016/j.neubiorev.2021.12.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 11/19/2021] [Accepted: 12/04/2021] [Indexed: 02/08/2023]
Abstract
Basic pain research has shed light on key cellular and molecular mechanisms underlying nociceptive and phenomenological aspects of pain. Despite these advances, [[we still yearn for] the discovery of novel therapeutic strategies to address the unmet needs of about 70% of chronic neuropathic pain patients whose pain fails to respond to opioids as well as to other conventional analgesic agents. Importantly, a substantial body of clinical observations over the past decade cumulatively suggests that the psychedelic class of drugs may possess heuristic value for understanding and treating chronic pain conditions. The present review presents a theoretical framework for hitherto insufficiently understood neuroscience-based mechanisms of psychedelics' potential analgesic effects. To that end, searches of PubMed-indexed journals were performed using the following Medical Subject Headings' terms: pain, analgesia, inflammatory, brain connectivity, ketamine, psilocybin, functional imaging, and dendrites. Recursive sets of scientific and clinical evidence extracted from this literature review were summarized within the following key areas: (1) studies employing psychedelics for alleviation of physical and emotional pain; (2) potential neuro-restorative effects of psychedelics to remediate the impaired connectivity underlying the dissociation between pain-related conscious states/cognitions and the subcortical activity/function leading to the eventual chronicity through immediate and long-term effects on dentritic plasticity; (3) anti-neuroinflammatory and pro-immunomodulatory actions of psychedelics as the may pertain to the role of these factors in the pathogenesis of neuropathic pain; (4) safety, legal, and ethical consideration inherent in psychedelics' pharmacotherapy. In addition to direct beneficial effects in terms of reduction of pain and suffering, psychedelics' inclusion in the analgesic armamentarium will contribute to deeper and more sophisticated insights not only into pain syndromes but also into frequently comorbid psychiatric condition associated with emotional pain, e.g., depressive and anxiety disorders. Further inquiry is clearly warranted into the above areas that have potential to evolve into further elucidate the mechanisms of chronic pain and affective disorders, and lead to the development of innovative, safe, and more efficacious neurobiologically-based therapeutic approaches.
Collapse
|
2
|
Jentzsch T, Cadotte DW, Wilson JR, Jiang F, Badhiwala JH, Akbar MA, Rocos B, Grossman RG, Aarabi B, Harrop JS, Fehlings MG. Spinal Cord Signal Change on Magnetic Resonance Imaging May Predict Worse Clinical In- and Outpatient Outcomes in Patients with Spinal Cord Injury: A Prospective Multicenter Study in 459 Patients. J Clin Med 2021; 10:4778. [PMID: 34682902 PMCID: PMC8537526 DOI: 10.3390/jcm10204778] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 09/22/2021] [Accepted: 10/04/2021] [Indexed: 12/16/2022] Open
Abstract
Prognostic factors for clinical outcome after spinal cord (SC) injury (SCI) are limited but important in patient management and education. There is a lack of evidence regarding magnetic resonance imaging (MRI) and clinical outcomes in SCI patients. Therefore, we aimed to investigate whether baseline MRI features predicted the clinical course of the disease. This study is an ancillary to the prospective North American Clinical Trials Network (NACTN) registry. Patients were enrolled from 2005-2017. MRI within 72 h of injury and a minimum follow-up of one year were available for 459 patients. Patients with American Spinal Injury Association impairment scale (AIS) E were excluded. Patients were grouped into those with (n = 354) versus without (n = 105) SC signal change on MRI T2-weighted images. Logistic regression analysis adjusted for commonly known a priori confounders (age and baseline AIS). Main outcomes and measures: The primary outcome was any adverse event. Secondary outcomes were AIS at the baseline and final follow-up, length of hospital stay (LOS), and mortality. A regression model adjusted for age and baseline AIS. Patients with intrinsic SC signal change were younger (46.0 (interquartile range (IQR) 29.0 vs. 50.0 (IQR 20.5) years, p = 0.039). There were no significant differences in the other baseline variables, gender, body mass index, comorbidities, and injury location. There were more adverse events in patients with SC signal change (230 (65.0%) vs. 47 (44.8%), p < 0.001; odds ratio (OR) = 2.09 (95% confidence interval (CI) 1.31-3.35), p = 0.002). The most common adverse event was cardiopulmonary (186 (40.5%)). Patients were less likely to be in the AIS D category with SC signal change at baseline (OR = 0.45 (95% CI 0.28-0.72), p = 0.001) and in the AIS D or E category at the final follow-up (OR = 0.36 (95% CI 0.16-0.82), p = 0.015). The length of stay was longer in patients with SC signal change (13.0 (IQR 17.0) vs. 11.0 (IQR 14.0), p = 0.049). There was no difference between the groups in mortality (11 (3.2%) vs. 4 (3.9%)). MRI SC signal change may predict adverse events and overall LOS in the SCI population. If present, patients are more likely to have a worse baseline clinical presentation (i.e., AIS) and in- or outpatient clinical outcome after one year. Patients with SC signal change may benefit from earlier, more aggressive treatment strategies and need to be educated about an unfavorable prognosis.
Collapse
Affiliation(s)
- Thorsten Jentzsch
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON M5T 2S8, Canada; (T.J.); (J.R.W.); (F.J.); (J.H.B.); (M.A.A.); (B.R.)
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, Toronto, ON M5G 2C4, Canada
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, 8008 Zurich, Switzerland
| | - David W. Cadotte
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Calgary Combined Spine Program, Hotchkiss Brain Institute, University of Calgary, Calgary, AB T2N 1N4, Canada;
| | - Jefferson R. Wilson
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON M5T 2S8, Canada; (T.J.); (J.R.W.); (F.J.); (J.H.B.); (M.A.A.); (B.R.)
- Division of Neurosurgery, St. Michael’s Hospital, University Health Network, Toronto, ON M5T 2S8, Canada
| | - Fan Jiang
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON M5T 2S8, Canada; (T.J.); (J.R.W.); (F.J.); (J.H.B.); (M.A.A.); (B.R.)
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, Toronto, ON M5G 2C4, Canada
| | - Jetan H. Badhiwala
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON M5T 2S8, Canada; (T.J.); (J.R.W.); (F.J.); (J.H.B.); (M.A.A.); (B.R.)
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, Toronto, ON M5G 2C4, Canada
| | - Muhammad A. Akbar
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON M5T 2S8, Canada; (T.J.); (J.R.W.); (F.J.); (J.H.B.); (M.A.A.); (B.R.)
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, Toronto, ON M5G 2C4, Canada
| | - Brett Rocos
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON M5T 2S8, Canada; (T.J.); (J.R.W.); (F.J.); (J.H.B.); (M.A.A.); (B.R.)
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, Toronto, ON M5G 2C4, Canada
| | - Robert G. Grossman
- Department of Neurosurgery, Houston Methodist Hospital, Houston, TX 77030, USA;
| | - Bizhan Aarabi
- Department of Neurosurgery, University of Maryland Medical Center and R Adams Cowley Shock Trauma Center, Baltimore, MD 21201, USA;
| | - James S. Harrop
- Departments of Neurological Surgery and Orthopedic Surgery, Thomas Jefferson University, Philadelphia, PA 19107, USA;
| | - Michael G. Fehlings
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON M5T 2S8, Canada; (T.J.); (J.R.W.); (F.J.); (J.H.B.); (M.A.A.); (B.R.)
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, Toronto, ON M5G 2C4, Canada
| |
Collapse
|
3
|
Evaluation of the analgesic effect of fentanyl-ketamine and fentanyl-lidocaine constant rate infusions in isoflurane-anesthetized dogs undergoing thoracolumbar hemilaminectomy. Vet Anaesth Analg 2021; 48:407-414. [PMID: 33736938 DOI: 10.1016/j.vaa.2021.01.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 01/13/2021] [Accepted: 01/26/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To evaluate anesthetic conditions and postoperative analgesia with the use of intraoperative constant rate infusions (CRIs) of fentanyl-lidocaine or fentanyl-ketamine in dogs undergoing thoracolumbar hemilaminectomy. STUDY DESIGN Prospective, randomized, blinded, clinical study. ANIMALS A total of 32 client-owned dogs. METHODS Dogs were premedicated with fentanyl (5 μg kg-1) administered intravenously (IV), anesthesia was induced with IV alfaxalone and maintained with isoflurane. Fentanyl (0.083 μg kg-1 minute-1) was infused IV with either ketamine (0.5 mg kg-1; then 40 μg kg-1 minute-1; group KF) or lidocaine (2 mg kg-1; then 200 μg kg-1 minute-1; group LF) assigned randomly. Heart rate, noninvasive arterial pressures, respiratory rate, esophageal temperature, end-tidal partial pressure of carbon dioxide and isoflurane concentration were recorded throughout anesthesia. Maintenance of anesthesia, recovery and postoperative pain (Glasgow Composite Pain Scale) were scored. Cardiopulmonary data were analyzed using a two-way anova with repeated measures, demographics of the two groups with a t test, and scores with Mann-Whitney U test, with p < 0.05. RESULTS All dogs recovered from anesthesia without complications. No significant difference was found between groups for cardiopulmonary variables, total anesthesia time, sedation score and requirement for postoperative sedation or for rescue analgesia. Anesthetic maintenance score was of lower quality in KF than in LF [median (interquartile range): 0 (0-0.5) versus 0 (0-0); p = 0.032)], but still considered ideal. Recovery score was higher and indicative of less sedation in LF than in KF [1 (1-1.5) versus 0.5 (0-1); p < 0.0001]. Pain score was higher in KF than in LF [2 (1-3) versus 1 (1-2); p = 0.0009]. CONCLUSIONS AND CLINICAL RELEVANCE Both CRIs of KF and LF provided adequate anesthetic conditions in dogs undergoing thoracolumbar hemilaminectomy. Based on requirement for rescue analgesia, postoperative analgesia was adequate in both groups.
Collapse
|
4
|
Rat ultrasonic vocalizations as a measure of the emotional component of chronic pain. Neuroreport 2019; 30:863-866. [DOI: 10.1097/wnr.0000000000001282] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
|
5
|
Abstract
Patients frequently come to the emergency department for pain. For decades, ketamine has been used in the emergency department for procedural sedation but is now receiving attention as a potential alternative to opioids because of its unique analgesic effects. Additionally, ketamine's dissociative properties have made it a popular choice for sedating profoundly agitated patients. In this narrative review, these new roles for ketamine in the emergency department are discussed.
Collapse
Affiliation(s)
- Sophia Sheikh
- Department of Emergency Medicine, University of Florida College of Medicine-Jacksonville, 655 West 8th Street, Jacksonville, FL, 32209, USA.
| | - Phyllis Hendry
- Department of Emergency Medicine, University of Florida College of Medicine-Jacksonville, 655 West 8th Street, Jacksonville, FL, 32209, USA
| |
Collapse
|
6
|
Abstract
PURPOSE OF REVIEW The development of acute to chronic pain involves distinct pathophysiological changes in the peripheral and central nervous systems. This article reviews the mechanisms, etiologies, and management of chronic pain syndromes with updates from recent findings in the literature. RECENT FINDINGS Chronic post-surgical pain (CPSP) is not limited to major surgeries and can develop after smaller procedures such as hernia repairs. While nerve injury has traditionally been thought to be the culprit for CPSP, it is evident that nerve-sparing surgical techniques are not completely preventative. Regional analgesia and agents such as ketamine, gabapentinoids, and COX-2 inhibitors have also been found to decrease the risks of developing chronic pain to varying degrees. Yet, given the correlation of central sensitization with the development of chronic pain, it is reasonable to utilize aggressive multimodal analgesia whenever possible. Development of chronic pain is typically a result of peripheral and central sensitization, with CPSP being one of the most common presentations. Using minimally invasive surgical techniques may reduce the risk of CPSP. Regional anesthetic techniques and preemptive analgesia should also be utilized when appropriate to reduce the intensity and duration of acute post-operative pain, which has been correlated with higher incidences of chronic pain.
Collapse
|
7
|
Kent ML, Hsia HLJ, Van de Ven TJ, Buchheit TE. Perioperative Pain Management Strategies for Amputation: A Topical Review. PAIN MEDICINE 2017; 18:504-519. [PMID: 27402960 DOI: 10.1093/pm/pnw110] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Objective To review acute pain management strategies in patients undergoing amputation with consideration of preoperative patient factors, pharmacologic/interventional modalities, and multidisciplinary care models to alleviate suffering in the immediate post-amputation setting. Background Regardless of surgical indication, patients undergoing amputation suffer from significant residual limb pain and phantom limb pain in the acute postoperative phase. Most studies have primarily focused on strategies to prevent persistent pain with inclusion of immediate postoperative outcomes as secondary measures. Pharmacologic agents, including gabapentin, ketamine, and calcitonin, and interventional modalities such as neuraxial and perineural catheters, have been examined in the perioperative period. Design Focused Literature Review. Results Pharmacologic agents (gabapentin, ketamine, calcitonin) have not shown consistent efficacy. Neuraxial analgesia has demonstrated both an opioid sparing and analgesic benefit while results have been mixed regarding perineural catheters in the immediate post-amputation setting. However, several early studies of perineural catheters employed sub-optimal techniques (distal surgical placement), and prolonged use of perineural catheters may provide a sustained benefit. Regardless of analgesic technique, a multidisciplinary approach is necessary for optimal care. Conclusion Patient-tailored analgesic regimens utilizing catheter-based techniques are essential in the acute post-amputation phase and should be implemented in all patients undergoing amputation. Future research should focus on improved measurement of acute pain and comparisons of effective analgesic regimens instead of single techniques.
Collapse
Affiliation(s)
- Michael L Kent
- Department of Anesthesiology, Walter Reed National Military Medical Center, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Hung-Lun John Hsia
- Department of Anesthesiology, Duke University Medical Center, Durham VA Medical Center, Durham, North Carolina, USA
| | - Thomas J Van de Ven
- Department of Anesthesiology, Duke University Medical Center, Durham VA Medical Center, Durham, North Carolina, USA
| | - Thomas E Buchheit
- Department of Anesthesiology, Duke University Medical Center, Durham VA Medical Center, Durham, North Carolina, USA
| |
Collapse
|
8
|
Landmann G, Chang EC, Dumat W, Lutz A, Müller R, Scheel-Sailer A, Schwerzmann K, Sigajew N, Ljutow A. [Pain in patients with paraplegia]. Schmerz 2017; 31:527-545. [PMID: 28940094 DOI: 10.1007/s00482-017-0250-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Chronic pain is one of the most reported health problems in patients suffering from spinal cord injuries and is described by the patients as one of the most burdensome sequelae of paraplegia. Various types of pain, such as nociceptive, neuropathic and other types of pain can occur. In addition, multiple pathophysiological mechanisms based on the biopsychosocial pain model play a role in the origins of the pain. These aspects necessitate a multimodal pain management approach in this patient group. This article presents an overview of the occurrence, importance and pathophysiology of chronic pain following spinal cord injury as well as diagnostic and therapeutic approaches.
Collapse
Affiliation(s)
- G Landmann
- Zentrum für Schmerzmedizin, Schweizer Paraplegiker-Zentrum, 6207, Nottwil, Guido-A.-Zäch-Str. 1, Schweiz.
| | - E-C Chang
- Zentrum für Schmerzmedizin, Schweizer Paraplegiker-Zentrum, 6207, Nottwil, Guido-A.-Zäch-Str. 1, Schweiz
| | - W Dumat
- Wenckebach-Klinikum, Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Berlin, Deutschland
| | - A Lutz
- Ergotherapie, Schweizer Paraplegiker-Zentrum, Nottwil, Schweiz
| | - R Müller
- Schweizer Paraplegiker-Forschung, Nottwil, Schweiz.,Department Gesundheitswissenschaften und Gesundheitspolitik, Universität Luzern, Luzern, Schweiz
| | - A Scheel-Sailer
- Department Gesundheitswissenschaften und Gesundheitspolitik, Universität Luzern, Luzern, Schweiz.,Forschung Rehabilitation Qualitätsmanagement, Schweizer Paraplegiker-Zentrum, Nottwil, Schweiz
| | - K Schwerzmann
- Zentrum für Schmerzmedizin, Schweizer Paraplegiker-Zentrum, 6207, Nottwil, Guido-A.-Zäch-Str. 1, Schweiz
| | - N Sigajew
- Zentrum für Schmerzmedizin, Schweizer Paraplegiker-Zentrum, 6207, Nottwil, Guido-A.-Zäch-Str. 1, Schweiz
| | - A Ljutow
- Zentrum für Schmerzmedizin, Schweizer Paraplegiker-Zentrum, 6207, Nottwil, Guido-A.-Zäch-Str. 1, Schweiz
| |
Collapse
|
9
|
Takai K, Taniguchi M. Modified dorsal root entry zone lesioning for intractable pain relief in patients with root avulsion injury. J Neurosurg Spine 2017; 27:178-184. [PMID: 28574334 DOI: 10.3171/2017.1.spine16234] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Dorsal root entry zone (DREZ) lesioning has been the most effective surgical treatment for the relief of intractable pain due to root avulsion injury, but residual pain and a decrease in pain relief in the follow-up period have been reported in 23%-70% of patients. Based on pain topography in the most recent studies on neuropathic pain, the authors modified the conventional DREZ lesioning procedure to improve clinical outcomes. The presumed rationale for this procedure is to eliminate the spontaneous discharges of neurons in the superficial spinal dorsal horn as well as wide dynamic range neurons in the deep spinal dorsal horn. METHODS Ten patients with avulsion-related pain underwent surgery between 2011 and 2015. The surgical procedure was described and postoperative pain relief was assessed as follows: excellent (residual pain never exceeded 3 on the visual analog scale [VAS] without medication), good (residual pain never exceeded 5 on the VAS with medication), and poor (residual pain was greater than 5 with medication). Specific perioperative complications were assessed. RESULTS The aim of this surgical procedure was to destroy the deeper layers of the posterior horn of spinal gray matter, which was in contrast to the procedures of Nashold and Sindou, which were to destroy the superficial layers. All patients achieved excellent (n = 7, pain relief without medication) or good (n = 3, pain relief with medication) pain relief postoperatively, and the recurrence of pain was not reported in any patients (median 29 months after surgery, range 12-64 months). Nine patients (90%) achieved complete pain relief (a score of 0 or 1 on the VAS) with or without medication. No surgical site complications such as infection or CSF leakage were noted. No motor deficit was observed in any patient. A sensory deficit was observed in 2 patients and disappeared within 1 month in 1 patient. New pain at the adjacent level of DREZ lesioning was observed in 3 patients and disappeared within 1 month in 2 patients. In the other patient, new pain persisted and required analgesics. CONCLUSIONS These preliminary results demonstrated that total and persistent global pain relief was achieved with the modified DREZ lesioning procedure in 90% of patients without major neurological deficits. The clinical improvements achieved by this modified surgical procedure support the hypothesis that not only the superficial layers, but also deeper layers of the spinal dorsal horn are associated with intractable pain due to root avulsion injury.
Collapse
Affiliation(s)
- Keisuke Takai
- Department of Neurosurgery, Tokyo Metropolitan Neurological Hospital, Tokyo, Japan
| | - Makoto Taniguchi
- Department of Neurosurgery, Tokyo Metropolitan Neurological Hospital, Tokyo, Japan
| |
Collapse
|
10
|
Hillhouse TM, Negus SS. Effects of the noncompetitive N-methyl-d-aspartate receptor antagonists ketamine and MK-801 on pain-stimulated and pain-depressed behaviour in rats. Eur J Pain 2016; 20:1229-40. [PMID: 26914635 DOI: 10.1002/ejp.847] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/01/2016] [Indexed: 12/22/2022]
Abstract
BACKGROUND Pain is a significant public health concern, and current pharmacological treatments have problematic side effects and limited effectiveness. N-methyl-d-aspartate (NMDA) glutamate receptor antagonists have emerged as one class of candidate treatments for pain because of the significant contribution of glutamate signalling in nociceptive processing. METHODS This study compared effects of the NMDA receptor antagonists ketamine and MK-801 in assays of pain-stimulated and pain-depressed behaviour in rats. The nonsteroidal anti-inflammatory drug ketoprofen was examined for comparison as a positive control. Intraperitoneal injection of dilute acid served as an acute visceral noxious stimulus to stimulate a stretching response or depress intracranial self-stimulation (ICSS) in male Sprague-Dawley rats. RESULTS Ketamine (1.0-10.0 mg/kg) blocked acid-stimulated stretching but failed to block acid-induced depression of ICSS, whereas MK-801 (0.01-0.1 mg/kg) blocked both acid-stimulated stretching and acid-induced depression of ICSS. These doses of ketamine and MK-801 did not alter control ICSS in the absence of the noxious stimulus; however, higher doses of ketamine (10 mg/kg) and MK-801 (0.32 mg/kg) depressed all behaviour. Ketoprofen (1.0 mg/kg) blocked both acid-induced stimulation of stretching and depression of ICSS without altering control ICSS. CONCLUSION These results support further consideration of NMDA receptor antagonists as analgesics; however, some NMDA receptor antagonists are more efficacious at attenuating pain-depressed behaviours. WHAT DOES THIS STUDY ADD NMDA receptor antagonists produce dissociable effects on pain-depressed behaviour. Provides evidence that pain-depressed behaviours should be considered and evaluated when determining the antinociceptive effects of NMDA receptor antagonists.
Collapse
Affiliation(s)
- T M Hillhouse
- Department of Pharmacology, University of Michigan, Ann Arbor, MI, USA.,Department of Pharmacology and Toxicology, Virginia Commonwealth University, Richmond, VA, USA
| | - S S Negus
- Department of Pharmacology and Toxicology, Virginia Commonwealth University, Richmond, VA, USA
| |
Collapse
|
11
|
Zhang C, Morozova AY, Abakumov MA, Gubsky IL, Douglas P, Feng S, Bryukhovetskiy AS, Chekhonin VP. Precise Delivery Into Chronic Spinal Cord Injury Syringomyelic Cysts with Magnetic Nanoparticles MRI Visualization. Med Sci Monit 2015; 21:3179-85. [PMID: 26486048 PMCID: PMC4621156 DOI: 10.12659/msm.895624] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Accepted: 10/02/2015] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Traumatic spinal cord injury (SCI) often results in the deficiency of glia and neurons in cystic cavities. These syringomyelic cysts can prevent axonal regeneration and sprouting. Details of the mechanism of syringomyelic cyst formation are unknown and an effective treatment for overcoming syringomyelic cysts is not available. MATERIAL AND METHODS Ten adult female Wistar rats underwent contusion SCI modeling resulting in syringomyelic cyst formation. A novel method for locating the cysts was developed and employed. MRI safe silver needles were inserted through the erector spinae of anesthetized rats to create a stable reference point. MRI images of the rodent spine were taken with the needles in situ. This information was used to accurately locate the cyst and determine the 3-dimensional entry point coordinates for nanoparticle delivery. Nanoparticles were injected into the cyst during a primary injection of 8 ul and a secondary injection of 8 ul, to prove the procedure can be accurately repeated. RESULTS None of the rats died intra- or post-operatively. The syringomyelic cysts were accurately located with the 3-dimensional entry point coordinates. After nanoparticle delivery twice into each rat, the visualized syringomyelic cyst volume significantly decreased from 5.71±0.21 mm3 to 3.23±0.364 mm3 and to 1.48±0.722 mm3. CONCLUSIONS The present study describes a novel strategy for precise nanoparticle delivery into a syringomyelic cyst, using measurements obtained from MRI images. This strategy may aid in developing a new method for studying chronic spinal cord injury and a novel treatment for syringomyelic cysts.
Collapse
Affiliation(s)
- Chao Zhang
- Department of Orthopedics, Tianjin Medical University General Hospital, Tianjin, P.R. China
- Department of Medicinal Nanobiotechnology, Pirogov Russian National Research Medical University, Moscow, Russian Federation
- Department of Basic and Applied Neurobiology, Federal Medical Research Center for Psychiatry and Narcology, Moscow, Russian Federation
| | - Anna Y. Morozova
- Department of Basic and Applied Neurobiology, Federal Medical Research Center for Psychiatry and Narcology, Moscow, Russian Federation
| | - Maxim A. Abakumov
- Department of Medicinal Nanobiotechnology, Pirogov Russian National Research Medical University, Moscow, Russian Federation
| | - Ilya L. Gubsky
- Department of Medicinal Nanobiotechnology, Pirogov Russian National Research Medical University, Moscow, Russian Federation
| | - Patricia Douglas
- Department of Orthopedics, Tianjin Medical University General Hospital, Tianjin, P.R. China
| | - Shiqing Feng
- Department of Orthopedics, Tianjin Medical University General Hospital, Tianjin, P.R. China
| | - Andrey S. Bryukhovetskiy
- Center for Biomedical Technologies, Federal Research and Clinical Center for Specialized Types of Medical Assistance and Medical Technologies of The Federal Medical Biological Agency, Moscow, Russian Federation
| | - Vladimir P. Chekhonin
- Department of Medicinal Nanobiotechnology, Pirogov Russian National Research Medical University, Moscow, Russian Federation
- Department of Basic and Applied Neurobiology, Federal Medical Research Center for Psychiatry and Narcology, Moscow, Russian Federation
| |
Collapse
|
12
|
Noreika DM, Coyne P. Discontinuance of life sustaining treatment utilizing ketamine for symptom management. J Pain Palliat Care Pharmacother 2015; 29:37-40. [PMID: 25625339 DOI: 10.3109/15360288.2014.1003686] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
We present the case of an otherwise healthy 21-year-old female who developed severe respiratory failure following a minor procedure requiring ECMO and bi-level ventilation. During her protracted ICU course, she had significant difficulties with agitation and was titrated to the following regimen: hydromorphone 30 mg/hour, fentanyl 200 mcg/hour, dexmedetomidine 1.5 mcg/kg/hour, propofol at 70 mcg/kg/min, and midazolam at 20 mg/hour. We were consulted to assist in withdrawal of life prolonging measures at the family's request and given high doses of commonly used opioid and sedative medications successfully utilized methadone and ketamine for symptom control. This case study would indicate that in selected patients on high dose opioid and sedative medications prior to withdrawal of life prolonging measures ketamine may be considered for symptom management.
Collapse
Affiliation(s)
- Danielle M Noreika
- Danielle M. Noreika is with the Thomas Palliative Care Unit and is a Clinical Assistant Professor, Division of Hematology, Oncology, and Palliative Care, Medical College of Virginia
| | | |
Collapse
|
13
|
|
14
|
O’Brien SL, Pangarkar S, Prager J. The Use of Ketamine in Neuropathic Pain. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2014. [DOI: 10.1007/s40141-014-0045-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
|
15
|
|
16
|
M'Dahoma S, Bourgoin S, Kayser V, Barthélémy S, Chevarin C, Chali F, Orsal D, Hamon M. Spinal cord transection-induced allodynia in rats--behavioral, physiopathological and pharmacological characterization. PLoS One 2014; 9:e102027. [PMID: 25019623 PMCID: PMC4096923 DOI: 10.1371/journal.pone.0102027] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2013] [Accepted: 06/14/2014] [Indexed: 12/31/2022] Open
Abstract
In humans, spinal cord lesions induce not only major motor and neurovegetative deficits but also severe neuropathic pain which is mostly resistant to classical analgesics. Better treatments can be expected from precise characterization of underlying physiopathological mechanisms. This led us to thoroughly investigate (i) mechanical and thermal sensory alterations, (ii) responses to acute treatments with drugs having patent or potential anti-allodynic properties and (iii) the spinal/ganglion expression of transcripts encoding markers of neuronal injury, microglia and astrocyte activation in rats that underwent complete spinal cord transection (SCT). SCT was performed at thoracic T8-T9 level under deep isoflurane anaesthesia, and SCT rats were examined for up to two months post surgery. SCT induced a marked hyper-reflexia at hindpaws and strong mechanical and cold allodynia in a limited (6 cm2) cutaneous territory just rostral to the lesion site. At this level, pressure threshold value to trigger nocifensive reactions to locally applied von Frey filaments was 100-fold lower in SCT- versus sham-operated rats. A marked up-regulation of mRNAs encoding ATF3 (neuronal injury) and glial activation markers (OX-42, GFAP, P2×4, P2×7, TLR4) was observed in spinal cord and/or dorsal root ganglia at T6-T11 levels from day 2 up to day 60 post surgery. Transcripts encoding the proinflammatory cytokines IL-1β, IL-6 and TNF-α were also markedly but differentially up-regulated at T6-T11 levels in SCT rats. Acute treatment with ketamine (50 mg/kg i.p.), morphine (3-10 mg/kg s.c.) and tapentadol (10-20 mg/kg i.p.) significantly increased pressure threshold to trigger nocifensive reaction in the von Frey filaments test, whereas amitriptyline, pregabalin, gabapentin and clonazepam were ineffective. Because all SCT rats developed long lasting, reproducible and stable allodynia, which could be alleviated by drugs effective in humans, thoracic cord transection might be a reliable model for testing innovative therapies aimed at reducing spinal cord lesion-induced central neuropathic pain.
Collapse
Affiliation(s)
- Saïd M'Dahoma
- Centre de Psychiatrie et Neurosciences, Institut National de la Santé et de la Recherche Médicale, INSERM U894, Université Paris Descartes, Paris, France
- Neuropsychopharmacologie, Faculté de Médecine Pierre et Marie Curie, site Pitié-Salpêtrière, Paris, France
- * E-mail:
| | - Sylvie Bourgoin
- Centre de Psychiatrie et Neurosciences, Institut National de la Santé et de la Recherche Médicale, INSERM U894, Université Paris Descartes, Paris, France
- Neuropsychopharmacologie, Faculté de Médecine Pierre et Marie Curie, site Pitié-Salpêtrière, Paris, France
| | - Valérie Kayser
- Centre de Psychiatrie et Neurosciences, Institut National de la Santé et de la Recherche Médicale, INSERM U894, Université Paris Descartes, Paris, France
- Neuropsychopharmacologie, Faculté de Médecine Pierre et Marie Curie, site Pitié-Salpêtrière, Paris, France
| | - Sandrine Barthélémy
- Centre de Psychiatrie et Neurosciences, Institut National de la Santé et de la Recherche Médicale, INSERM U894, Université Paris Descartes, Paris, France
- Neuropsychopharmacologie, Faculté de Médecine Pierre et Marie Curie, site Pitié-Salpêtrière, Paris, France
| | - Caroline Chevarin
- Centre de Psychiatrie et Neurosciences, Institut National de la Santé et de la Recherche Médicale, INSERM U894, Université Paris Descartes, Paris, France
- Neuropsychopharmacologie, Faculté de Médecine Pierre et Marie Curie, site Pitié-Salpêtrière, Paris, France
| | - Farah Chali
- Laboratoire de Neurobiologie des Signaux Intercellulaires, Centre National de la Recherche Scientifique, CNRS UMR 7101, Université Pierre et Marie Curie, Paris, France
| | - Didier Orsal
- Laboratoire de Neurobiologie des Signaux Intercellulaires, Centre National de la Recherche Scientifique, CNRS UMR 7101, Université Pierre et Marie Curie, Paris, France
| | - Michel Hamon
- Centre de Psychiatrie et Neurosciences, Institut National de la Santé et de la Recherche Médicale, INSERM U894, Université Paris Descartes, Paris, France
- Neuropsychopharmacologie, Faculté de Médecine Pierre et Marie Curie, site Pitié-Salpêtrière, Paris, France
| |
Collapse
|