1
|
Jing F, Huang H, Li Y, Zang P. Vertebrobasilar dolichoectasia to trigeminal neuralgia: case report. J Surg Case Rep 2024; 2024:rjad737. [PMID: 38239380 PMCID: PMC10795936 DOI: 10.1093/jscr/rjad737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 12/26/2023] [Indexed: 01/22/2024] Open
Abstract
Vertebrobasilar dolichoectasia (VBD) is a dilated arterial disease with a diameter ˃4.5 mm. Trigeminal neuralgia (TN) is chronic neuropathic pain. Through the diagnosis and treatment of this case we believe that there is a significant risk associated with the endovascular treatment of VBD. The development of post-operative complications caused some functional impairment to the patient, but the improvement in TN symptoms with this endovascular treatment was unexpected. This treatment procedure was considered to be possibly related to the alteration of the tortuous path of the vessels, changing their course, allowing the displacement of vascular compression in the trigeminal root entry zone, and possibly also altering the hemodynamics of the posterior circulation, improving the progression of ischemia and hypoxia-induced demyelination of the trigeminal nerve. Due to the low incidence of this disease, there are not enough large sample studies for systematic statistical analysis.
Collapse
Affiliation(s)
- Fangkun Jing
- Department of Neurosurgery, The People's Hospital of Liaoning Province, Shenyang, Liaoning, China
| | - Haitao Huang
- Department of Neurosurgery, The People's Hospital of Liaoning Province, Shenyang, Liaoning, China
| | - Yanfeng Li
- Department of Neurosurgery, The People's Hospital of Liaoning Province, Shenyang, Liaoning, China
| | - Peizhuo Zang
- Department of Neurosurgery, The People's Hospital of Liaoning Province, Shenyang, Liaoning, China
| |
Collapse
|
2
|
Xiromerisiou G, Lampropoulos IC, Dermitzakis EV, Vikelis M, Marogianni C, Mysiris D, Argyriou AA. Single OnabotulinumtoxinA Session Add-On to Carbamazepine or Oxcarbazepine in Treatment-Refractory Trigeminal Neuralgia: A Case Series with 24-Week Follow Up. Toxins (Basel) 2023; 15:539. [PMID: 37755965 PMCID: PMC10534438 DOI: 10.3390/toxins15090539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 08/09/2023] [Accepted: 08/22/2023] [Indexed: 09/28/2023] Open
Abstract
We sought to assess the efficacy of combining onabotulinumtoxinA (BoNTA) as add-on therapy to carbamazepine or oxcarbazepine in treatment-refractory patients with trigeminal neuralgia (TGN) who failed to respond (less than 30% response rate) to adequate monotherapy. We conducted a retrospective study on 15 patients with a definite diagnosis of TGN, according to the established criteria, and underwent BoNTA as part of their treatment plan. A single BoNTA session was administered subcutaneously, according to patients' perceived zone of pain, at different dosages ranging from 30 to 200 units (mean ± standard deviation: 87.3 ± 39.2). All patients (15/15; 100%) reported large reductions in the severity of their TGN-related neuropathic pain. The mean pain score on the VAS scale significantly decreased from 9.3 ± 1.1 to 3.7 ± 1.2 at 2 weeks after injecting BoNTA (p < 0.001) and remained stable at 4 and 24 weeks post-injection. Regarding the impact of BoNTA on patients' health-related quality of life, there were significant improvements in both the physical and mental health domains (p < 0.05) of SF-36 tool. BoNTA may be a safe and effective treatment option for patients with refractory TGN when added on to carbamazepine or oxcarbazepine. The use of a single BoNTA session for TGN treatment may be an alternative to surgical interventions and as add-on treatment to oral medications, providing patients with a minimally invasive, effective, safe and well-tolerated option.
Collapse
Affiliation(s)
- Georgia Xiromerisiou
- Department of Neurology, Faculty of Medicine, School of Health Sciences, University Hospital of Larissa, 41110 Larissa, Greece
| | - Ioannis C. Lampropoulos
- Respiratory Medicine Department, Faculty of Medicine, University of Thessaly, 41110 Larissa, Greece;
| | | | - Michail Vikelis
- Headache Clinic, Mediterraneo Hospital, 16675 Glyfada, Greece;
| | - Chrysoula Marogianni
- Faculty of Medicine, School of Health Sciences, University Hospital of Larissa, 41110 Larissa, Greece; (C.M.); (D.M.)
| | - Dimitrios Mysiris
- Faculty of Medicine, School of Health Sciences, University Hospital of Larissa, 41110 Larissa, Greece; (C.M.); (D.M.)
| | - Andreas A. Argyriou
- Headache Outpatient Clinic, Department of Neurology, Agios Andreas State General Hospital of Patras, 26335 Patras, Greece;
| |
Collapse
|
3
|
Zhang H, Liu M, Guo W, He J, Li J. The Effect of Trigeminal Ganglion Block on Trigeminocardiac Reflex in Elderly Patients with Trigeminal Neuralgia Undergoing Percutaneous Balloon Compression: A Randomized Controlled Study. Ther Clin Risk Manag 2022; 18:1091-1098. [DOI: 10.2147/tcrm.s373370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 11/18/2022] [Indexed: 12/13/2022] Open
|
4
|
Yang R, Song Y, Wang H, Chen C, Bai F, Li C. BmK DKK13, A Scorpion Toxin, Alleviates Pain Behavior in a Rat Model of Trigeminal Neuralgia by Modulating Voltage-Gated Sodium Channels and MAPKs/CREB Pathway. Mol Neurobiol 2022; 59:4535-4549. [PMID: 35579847 DOI: 10.1007/s12035-022-02855-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 04/27/2022] [Indexed: 12/01/2022]
Abstract
BmK DKK13 (DKK13) is a mutated recombinant peptide, which has a significant antinociception in a rat model of the inflammatory pain. The purpose of this study was to evaluate the antinociceptive effect of DKK13 on trigeminal neuralgia (TN) in rats. Male Sprague-Dawley (SD) rats were treated with the chronic constriction injury of the infraorbital nerve (IoN-CCI) model to induce stable symptoms of TN. DKK13 (1.0 mg/kg, 2.0 mg/kg and 4.0 mg/kg, i.v.) or morphine (4.0 mg/kg, i.v.) was administered by tail vein once on day 14 after IoN-CCI injury. Behavioral tests, electrophysiology and western blotting were performed to investigate the role and underlying mechanisms of DKK13 on IoN-CCI model. Behavioral test results showed that DKK13 could significantly increase the mechanical pain and thermal radiation pain thresholds of IoN-CCI rats and inhibit the asymmetric spontaneous pain scratching behavior. Electrophysiological results showed that DKK13 could significantly reduce the current density of Nav1.8 in the ipsilateral side of trigeminal ganglion (TG) neurons in IoN-CCI rats, and the steady-state activation and inactivation curves of Nav1.8 shifted, respectively, to the direction of hyperpolarization and depolarization. Western blotting results showed that DKK13 significantly reduced the expression of Nav1.8 and the phosphorylation levels of key proteins of MAPKs/CREB pathway in TG tissues of IoN-CCI rats. In brief, DKK13 has a significant antinociceptive effect on IoN-CCI rats, which may be achieved by changing the dynamic characteristics of Nav1.8 channel and regulating the protein phosphorylation in MAPKs/CREB pathway.
Collapse
Affiliation(s)
- Ran Yang
- Department of Pharmacology, Shenyang Pharmaceutical University, Shenyang, 110016, China
| | - Yongbo Song
- School of Life Sciences and Biopharmaceutical Science, Shenyang Pharmaceutical University, Shenyang, 110016, China
| | - Haipeng Wang
- Department of Pharmacology, Shenyang Pharmaceutical University, Shenyang, 110016, China
| | - Chunyun Chen
- Department of Pharmacology, Shenyang Pharmaceutical University, Shenyang, 110016, China
| | - Fei Bai
- Department of Pharmacology, Shenyang Pharmaceutical University, Shenyang, 110016, China
| | - Chunli Li
- Department of Pharmacology, Shenyang Pharmaceutical University, Shenyang, 110016, China.
| |
Collapse
|
5
|
Aglio LS, Mezzalira E, Mendez-Pino L, Corey SM, Fields KG, Abbakar R, Baez LA, Kelly-Aglio NJ, Vetter T, Jamison RN, Edwards RR. Surgical Prehabilitation: Strategies and Psychological Intervention to Reduce Postoperative Pain and Opioid Use. Anesth Analg 2022; 134:1106-1111. [PMID: 35427271 DOI: 10.1213/ane.0000000000005963] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Linda S Aglio
- From the Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.,Computational Neurosurgical Outcome Center, Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Elisabetta Mezzalira
- Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Laura Mendez-Pino
- From the Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Sarah M Corey
- From the Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Kara G Fields
- From the Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Reem Abbakar
- From the Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Leah A Baez
- From the Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Nicole J Kelly-Aglio
- Computational Neurosurgical Outcome Center, Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Thomas Vetter
- Department of Surgery and Perioperative Care, Dell Medical School at the University of Texas at Austin, Austin, Texas
| | - Robert N Jamison
- From the Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Robert R Edwards
- From the Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
6
|
Nrf2 Activation Mediates Antiallodynic Effect of Electroacupuncture on a Rat Model of Complex Regional Pain Syndrome Type-I through Reducing Local Oxidative Stress and Inflammation. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2022; 2022:8035109. [PMID: 35498128 PMCID: PMC9054487 DOI: 10.1155/2022/8035109] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 12/29/2021] [Indexed: 12/15/2022]
Abstract
Complex regional pain syndrome type-I (CRPS-I) represents a type of neurovascular condition featured by severe pain in affected extremities. Few treatments have proven effective for CRPS-I. Electroacupuncture (EA) is an effective therapy for pain relief. We explored the mechanism through which EA ameliorates pain in a rat CRPS-I model. The chronic postischemic pain (CPIP) model was established using Sprague-Dawley rats to mimic CRPS-I. We found that oxidative stress-related biological process was among the predominant biological processes in affected hindpaw of CPIP rats. Oxidative stress occurred primarily in local hindpaw but not in the spinal cord or serum of model rats. Antioxidant N-acetyl cysteine (NAC) attenuated mechanical allodynia and spinal glia overactivation in CPIP model rats, whereas locally increasing oxidative stress is sufficient to induce chronic pain and spinal glia overactivation in naive rats. EA exerted remarkable antiallodynia on CPIP rats by reducing local oxidative stress via enhancing nuclear factor erythroid 2-related factor 2 (Nrf2) expression. Pharmacological blocking Nrf2 abolished antioxidative and antiallodynic effects of EA. EA reduced spinal glia overactivation, attenuated the upregulation of inflammatory cytokines, reduced the enhanced TRPA1 channel activity in dorsal root ganglion neurons innervating the hindpaws, and improved blood flow dysfunction in hindpaws of CPIP rats, all of which were mimicked by NAC treatment. Thus, we identified local oxidative injury as an important contributor to pathogenesis of animal CRPS-I model. EA targets local oxidative injury by enhancing endogenous Nrf2-mediated antioxidative mechanism to relieve pain and inflammation. Our study indicates EA can be an alternative option for CRPS-I management.
Collapse
|
7
|
Yin C, Shen W, Zhang M, Wen L, Huang R, Sun M, Gao Y, Xiong W. Inhibitory Effects of Palmatine on P2X7 Receptor Expression in Trigeminal Ganglion and Facial Pain in Trigeminal Neuralgia Rats. Front Cell Neurosci 2021; 15:672022. [PMID: 34366788 PMCID: PMC8339261 DOI: 10.3389/fncel.2021.672022] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 06/01/2021] [Indexed: 11/13/2022] Open
Abstract
Trigeminal Neuralgia (TN) refers to recurrent severe paroxysmal pain in the distribution area of the trigeminal nerve, which seriously affects the quality of life of patients. This research applied the chronic constriction injury of the infraorbital nerve (CCI—ION) approach to induce an animal model of TN in rats. The mechanical pain threshold of each group of rats was determined postoperatively; the expression of P2X7 receptor in trigeminal ganglion (TG) was assessed by qRT-PCR, immunofluorescence and Western blot; and the changes of the proinflammatory cytokines IL-1β and TNF-α in serum of rats were detected by ELISA. The results showed that the administration of palmatine in the TN rats could reduce the mechanical pain threshold, significantly decrease the expression of P2X7 receptor in TG, and lower the serum concentrations of IL-1β and TNF-α, compared to the sham group. In addition, the phosphorylation level of p38 in TG of TN rats was significantly decreased after treatment with palmatine. Likewise, inhibition of P2X7 expression by shRNA treatment could effectively counteract the adversary changes of pain sensitivity, IL-1β and TNF-α production, and p38 phosphorylation in TN rats. Our data suggest that palmatine may alleviate mechanical facial pain in TN rats possibly by reducing the expression of P2X7 receptor in TG of TN rats, which may be attributable to inhibiting p38 phosphorylation and reducing the release of IL-1β and TNF-α.
Collapse
Affiliation(s)
- Cancan Yin
- Affiliated Stomatological Hospital of Nanchang University, Nanchang, China.,Hangzhou Stomatology Hospital, Hangzhou, China
| | - Wenhao Shen
- Affiliated Stomatological Hospital of Nanchang University, Nanchang, China
| | - Mingming Zhang
- Department of Physiology, Basic Medical College, Nanchang University, Nanchang, China
| | - Lequan Wen
- Joint Program of Nanchang University and Queen Mary University of London, Nanchang, China
| | - Ruoyu Huang
- Affiliated Stomatological Hospital of Nanchang University, Nanchang, China
| | - Mengyun Sun
- Department of Physiology, Basic Medical College, Nanchang University, Nanchang, China
| | - Yun Gao
- Department of Physiology, Basic Medical College, Nanchang University, Nanchang, China.,Jiangxi Provincial Key Laboratory of Autonomic Nervous Function and Disease, Nanchang, China
| | - Wei Xiong
- Affiliated Stomatological Hospital of Nanchang University, Nanchang, China.,Jiangxi Provincial Key Laboratory of Oral Biomedicine, Nanchang, China
| |
Collapse
|
8
|
Abstract
Background Trigeminal neuralgia (TN) is a painful condition, often leading to poor quality of life. Objective The aim of this review was to discuss the various treatment modalities for the medical management of TN. Materials and Methods We reviewed the available literature on TN in clinical databases including PubMed, Google Scholar, and the Cochrane Database of Systematic Reviews, with a specific focus on the pharmacological treatment and newer drugs under development for the treatment of TN. Results Carbamazepine (CBZ) is the gold standard of treatment for TN. The first-line drugs for the treatment of TN are CBZ and oxcarbazepine (OXC). A proportion of cases (30%) are initially resistant to the first-line drugs. Alternative drugs need to be considered if the first-line drugs are not well tolerated or become ineffective with prolonged therapy. The second-line drugs comprise lamotrigine, baclofen, gabapentin, and pregabalin used as monotherapy or in combination with CBZ/OXC. Botulinum toxin A may be a promising presurgical option. Newer drug like vixotrigine has shown good results in phase two randomized control trials. About 50% of cases develop treatment resistance to oral drugs over the subsequent years of therapy and require surgical options. Conclusion The first-line drugs for the treatment of TN (irrespective of the age group or type) are CBZ and OXC. Combination therapy with second-line or other drugs may become necessary with poor response to CBZ/OXC, or if adverse events occur. Patients should be offered surgical options if there is poor response or tolerance to the medical therapy.
Collapse
Affiliation(s)
- Satish V Khadilkar
- Department of Neurology, Bombay Hospital Institute of Medical Sciences, New Marine Lines, Mumbai, Maharashtra, India
| | - Varsha A Patil
- Associate Consultant Neurologist , Bombay Hospital Institute of Medical Sciences, New Marine Lines, Mumbai, Maharashtra, India
| |
Collapse
|
9
|
Doshi TL, Dworkin RH, Polomano RC, Carr DB, Edwards RR, Finnerup NB, Freeman RL, Paice JA, Weisman SJ, Raja SN. AAAPT Diagnostic Criteria for Acute Neuropathic Pain. PAIN MEDICINE 2021; 22:616-636. [PMID: 33575803 DOI: 10.1093/pm/pnaa407] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Acute neuropathic pain is a significant diagnostic challenge, and it is closely related to our understanding of both acute pain and neuropathic pain. Diagnostic criteria for acute neuropathic pain should reflect our mechanistic understanding and provide a framework for research on and treatment of these complex pain conditions. METHODS The Analgesic, Anesthetic, and Addiction Clinical Trial Translations, Innovations, Opportunities, and Networks (ACTTION) public-private partnership with the U.S. Food and Drug Administration (FDA), the American Pain Society (APS), and the American Academy of Pain Medicine (AAPM) collaborated to develop the ACTTION-APS-AAPM Pain Taxonomy (AAAPT) for acute pain. A working group of experts in research and clinical management of neuropathic pain was convened. Group members used literature review and expert opinion to develop diagnostic criteria for acute neuropathic pain, as well as three specific examples of acute neuropathic pain conditions, using the five dimensions of the AAAPT classification of acute pain. RESULTS AAAPT diagnostic criteria for acute neuropathic pain are presented. Application of these criteria to three specific conditions (pain related to herpes zoster, chemotherapy, and limb amputation) illustrates the spectrum of acute neuropathic pain and highlights unique features of each condition. CONCLUSIONS The proposed AAAPT diagnostic criteria for acute neuropathic pain can be applied to various acute neuropathic pain conditions. Both the general and condition-specific criteria may guide future research, assessment, and management of acute neuropathic pain.
Collapse
Affiliation(s)
- Tina L Doshi
- Department of Anesthesiology and Critical Care Medicine, Division of Pain Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Robert H Dworkin
- Department of Anesthesiology, University of Rochester School of Medicine and Dentistry, Rochester, New York, and Department of Neurology, Center for Human Experimental Therapeutics, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Rosemary C Polomano
- Division of Biobehavioral Health Sciences, University of Pennsylvania-School of Nursing, Philadelphia, Pennsylvania, USA
| | - Daniel B Carr
- Public Health and Community Medicine Program, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Robert R Edwards
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Nanna B Finnerup
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, and Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | - Roy L Freeman
- Center for Autonomic and Peripheral Nerve Disorders, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Judith A Paice
- Cancer Pain Program, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
| | - Steven J Weisman
- Jane B. Pettit Pain and Headache Center, Children's Wisconsin, Departments of Anesthesiology and Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Srinivasa N Raja
- Department of Anesthesiology and Critical Care Medicine, Division of Pain Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| |
Collapse
|
10
|
Chronic Pain Diagnosis Using Machine Learning, Questionnaires, and QST: A Sensitivity Experiment. Diagnostics (Basel) 2020; 10:diagnostics10110958. [PMID: 33212774 PMCID: PMC7697204 DOI: 10.3390/diagnostics10110958] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 11/13/2020] [Indexed: 11/17/2022] Open
Abstract
In the last decade, machine learning has been widely used in different fields, especially because of its capacity to work with complex data. With the support of machine learning techniques, different studies have been using data-driven approaches to better understand some syndromes like mild cognitive impairment, Alzheimer’s disease, schizophrenia, and chronic pain. Chronic pain is a complex disease that can recurrently be misdiagnosed due to its comorbidities with other syndromes with which it shares symptoms. Within that context, several studies have been suggesting different machine learning algorithms to classify or predict chronic pain conditions. Those algorithms were fed with a diversity of data types, from self-report data based on questionnaires to the most advanced brain imaging techniques. In this study, we assessed the sensitivity of different algorithms and datasets classifying chronic pain syndromes. Together with this assessment, we highlighted important methodological steps that should be taken into account when an experiment using machine learning is conducted. The best results were obtained by ensemble-based algorithms and the dataset containing the greatest diversity of information, resulting in area under the receiver operating curve (AUC) values of around 0.85. In addition, the performance of the algorithms is strongly related to the hyper-parameters. Thus, a good strategy for hyper-parameter optimization should be used to extract the most from the algorithm. These findings support the notion that machine learning can be a powerful tool to better understand chronic pain conditions.
Collapse
|
11
|
Wang J, Zheng X, Liu B, Yin C, Chen R, Li X, Li Y, Nie H, Zeng D, He X, Jiang Y, Fang J, Liu B. Electroacupuncture Alleviates Mechanical Allodynia of a Rat Model of CRPS-I and Modulates Gene Expression Profiles in Dorsal Root Ganglia. Front Neurol 2020; 11:580997. [PMID: 33193035 PMCID: PMC7661737 DOI: 10.3389/fneur.2020.580997] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 09/30/2020] [Indexed: 12/19/2022] Open
Abstract
Complex regional pain syndrome type-I (CRPS-I) is chronic neurological disorder accompanied with devastating pain. Most conventional medical treatments lack effectiveness, making CRPS-I a challenging clinical condition. Electroacupuncture (EA) showed effectiveness in alleviating the pain symptoms of CRPS-I patients. However, the molecular mechanisms underlying EA's therapeutic effect are still not well-understood. Here, we established the rat chronic post-ischemic pain (CPIP) model to mimic CRPS-I and performed repetitive EA on bilateral hind limbs of the CPIP model rats. We then performed RNA-sequencing (RNA-Seq) to study the differences in gene expression, gene networks, and molecular pathways in ipsilateral DRGs innervating the hind limb of the CPIP model rats with and without repetitive EA treatment. Our results found that repetitive EA treatment significantly alleviated mechanical allodynia in bilateral hind limbs of CPIP model rats. RNA-Seq analysis indicated that EA modulated the expression of multiple genes and gene networks in the DRGs of CPIP model rats. Further bioinformatics analysis identified the up-regulation of an array of genes involved in biological process such as neutrophil chemotaxis and immune response in the DRGs of CPIP model rats after EA treatment. Thus, these results suggest that EA may alleviate pain response in CPIP model rats via regulating multiple genes. Our work may help to further advance the understandings of the molecular mechanisms underlying EA's therapeutic effects on CRPS-I and help to identify novel targets for CRPS-I treatment.
Collapse
Affiliation(s)
- Jie Wang
- Key Laboratory of Acupuncture and Neurology of Zhejiang Province, Department of Neurobiology and Acupuncture Research, The Third Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China
| | - Xiaoli Zheng
- Key Laboratory of Acupuncture and Neurology of Zhejiang Province, Department of Neurobiology and Acupuncture Research, The Third Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China
| | - Boyu Liu
- Key Laboratory of Acupuncture and Neurology of Zhejiang Province, Department of Neurobiology and Acupuncture Research, The Third Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China
| | - Chengyu Yin
- Key Laboratory of Acupuncture and Neurology of Zhejiang Province, Department of Neurobiology and Acupuncture Research, The Third Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China
| | - Ruixiang Chen
- Key Laboratory of Acupuncture and Neurology of Zhejiang Province, Department of Neurobiology and Acupuncture Research, The Third Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China
| | - Xiaojie Li
- Key Laboratory of Acupuncture and Neurology of Zhejiang Province, Department of Neurobiology and Acupuncture Research, The Third Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China
| | - Yuanyuan Li
- Key Laboratory of Acupuncture and Neurology of Zhejiang Province, Department of Neurobiology and Acupuncture Research, The Third Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China
| | - Huimin Nie
- Key Laboratory of Acupuncture and Neurology of Zhejiang Province, Department of Neurobiology and Acupuncture Research, The Third Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China
| | - Danyi Zeng
- Key Laboratory of Acupuncture and Neurology of Zhejiang Province, Department of Neurobiology and Acupuncture Research, The Third Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China
| | - Xiaofen He
- Key Laboratory of Acupuncture and Neurology of Zhejiang Province, Department of Neurobiology and Acupuncture Research, The Third Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China
| | - Yongliang Jiang
- Key Laboratory of Acupuncture and Neurology of Zhejiang Province, Department of Neurobiology and Acupuncture Research, The Third Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China
| | - Jianqiao Fang
- Key Laboratory of Acupuncture and Neurology of Zhejiang Province, Department of Neurobiology and Acupuncture Research, The Third Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China
| | - Boyi Liu
- Key Laboratory of Acupuncture and Neurology of Zhejiang Province, Department of Neurobiology and Acupuncture Research, The Third Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China
| |
Collapse
|
12
|
Affiliation(s)
- Giorgio Cruccu
- From the Department of Human Neuroscience, Sapienza University of Rome, Rome
| | - Giulia Di Stefano
- From the Department of Human Neuroscience, Sapienza University of Rome, Rome
| | - Andrea Truini
- From the Department of Human Neuroscience, Sapienza University of Rome, Rome
| |
Collapse
|
13
|
Woolf CJ. Capturing Novel Non-opioid Pain Targets. Biol Psychiatry 2020; 87:74-81. [PMID: 31399256 PMCID: PMC6898770 DOI: 10.1016/j.biopsych.2019.06.017] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 06/07/2019] [Accepted: 06/24/2019] [Indexed: 12/29/2022]
Abstract
The relatively high efficacy of opioids, which have associated risks of addiction, tolerance, and dependence, for the management of acute and terminal pain has been a major driver of the opioid crisis, together with the availability, overprescription, and diversion of these drugs. Eliminating opioids without an effective replacement is, however, no solution, as it substitutes one major problem with another. To deal successfully with the opioid crisis, we need to discover novel analgesics whose mechanisms do not involve the mu opioid receptor but that have high analgesic potency and low risk of adverse effects, particularly no abuse liability. The question is how to achieve this. There are several necessary elements; first, we need to understand the nature of pain and the mechanisms responsible for it, and second, we need to adopt novel and unbiased approaches to the identification and validation of pain targets.
Collapse
Affiliation(s)
- Clifford J Woolf
- F.M. Kirby Neurobiology Center, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts.
| |
Collapse
|
14
|
Santana AN, Cifre I, de Santana CN, Montoya P. Using Deep Learning and Resting-State fMRI to Classify Chronic Pain Conditions. Front Neurosci 2019; 13:1313. [PMID: 31920483 PMCID: PMC6929667 DOI: 10.3389/fnins.2019.01313] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 11/25/2019] [Indexed: 12/11/2022] Open
Abstract
Chronic pain is known as a complex disease due to its comorbidities with other symptoms and the lack of effective treatments. As a consequence, chronic pain seems to be under-diagnosed in more than 75% of patients. At the same time, the advance in brain imaging, the popularization of machine learning techniques and the development of new diagnostic tools based on these technologies have shown that these tools could be an option in supporting decision-making of healthcare professionals. In this study, we computed functional brain connectivity using resting-state fMRI data from one hundred and fifty participants to assess the performance of different machine learning models, including deep learning (DL) neural networks in classifying chronic pain patients and pain-free controls. The best result was obtained by training a convolutional neural network fed with data preprocessed using the MSDL probabilistic atlas and using the dynamic time warping (DTW) as connectivity measure. DL models had a better performance compared to other less costly models such as support vector machine (SVM) and RFC, with balanced accuracy ranged from 69 to 86%, while the area under the curve (ROC) ranged from 0.84 to 0.93. Also, DTW overperformed correlation as connectivity measure. These findings support the notion that resting-state fMRI data could be used as a potential biomarker of chronic pain conditions.
Collapse
Affiliation(s)
- Alex Novaes Santana
- Research Institute of Health Sciences (IUNICS-IdISBa), University of the Balearic Islands, Palma, Spain
| | - Ignacio Cifre
- Facultat de Psicologia, Ciències de l'Educació i de l'Esport, Blanquerna, Universitat Ramon Llull, Barcelona, Spain
| | | | - Pedro Montoya
- Research Institute of Health Sciences (IUNICS-IdISBa), University of the Balearic Islands, Palma, Spain
| |
Collapse
|
15
|
Bhakta P, Reazaul Karim HM, O’Brien B, Vassallo MC, Leliveld MS, Kamphuis SJM, Verhofstad MHJ. An infrapatellar nerve block reduces knee pain in patients with chronic anterior knee pain after tibial nailing: a randomized, placebo-controlled trial in 34 patients. Acta Orthop 2019; 90:505-506. [PMID: 31296091 PMCID: PMC6746275 DOI: 10.1080/17453674.2019.1640413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
|