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Devarajan J, Mena S, Cheng J. Mechanisms of complex regional pain syndrome. FRONTIERS IN PAIN RESEARCH 2024; 5:1385889. [PMID: 38828388 PMCID: PMC11140106 DOI: 10.3389/fpain.2024.1385889] [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: 02/14/2024] [Accepted: 04/16/2024] [Indexed: 06/05/2024] Open
Abstract
Complex Regional Pain Syndrome (CRPS) is a chronic pain disorder characterized by a diverse array of symptoms, including pain that is disproportionate to the initial triggering event, accompanied by autonomic, sensory, motor, and sudomotor disturbances. The primary pathology of both types of CRPS (Type I, also known as reflex sympathetic dystrophy, RSD; Type II, also known as causalgia) is featured by allodynia, edema, changes in skin color and temperature, and dystrophy, predominantly affecting extremities. Recent studies started to unravel the complex pathogenic mechanisms of CRPS, particularly from an autoimmune and neuroimmune interaction perspective. CRPS is now recognized as a systemic disease that stems from a complex interplay of inflammatory, immunologic, neurogenic, genetic, and psychologic factors. The relative contributions of these factors may vary among patients and even within a single patient over time. Key mechanisms underlying clinical manifestations include peripheral and central sensitization, sympathetic dysregulation, and alterations in somatosensory processing. Enhanced understanding of the mechanisms of CRPS is crucial for the development of effective therapeutic interventions. While our mechanistic understanding of CRPS remains incomplete, this article updates recent research advancements and sheds light on the etiology, pathogenesis, and molecular underpinnings of CRPS.
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Affiliation(s)
- Jagan Devarajan
- Department of Pain Management, Neurological Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Shayla Mena
- Department of Pain Management, Neurological Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Jianguo Cheng
- Department of Pain Management and Neurosciences, Neurological Institute, Cleveland Clinic, Cleveland, OH, United States
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Sobeeh MG, Hassan KA, Silva AG, Bruehl S. Impact of different CRPS phenotypes and diagnostic criteria on quantitative sensory testing outcomes: systematic review and meta-analysis. PAIN MEDICINE (MALDEN, MASS.) 2024; 25:211-225. [PMID: 37930043 DOI: 10.1093/pm/pnad144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 10/11/2023] [Accepted: 10/13/2023] [Indexed: 11/07/2023]
Abstract
OBJECTIVES This review and meta-analysis evaluated the impact of diagnostic criteria and clinical phenotypes on quantitative sensory testing (QST) outcomes in patients with complex regional pain syndrome (CRPS). METHODS Eight databases were searched based on a previously published protocol. Forty studies comparing QST outcomes between CRPS-I vs II, warm vs cold CRPS, upper vs lower limb CRPS, males vs females, or using Budapest vs older IASP criteria were included. RESULTS Studies investigating QST differences between CRPS-I vs II (n = 4), between males vs females (n = 2), and between upper and lower limb CRPS (n = 2) showed no significant differences. Four studies compared QST outcomes in warm vs cold CRPS, showing heat hyperalgesia in warm CRPS, with thermal and mechanical sensory loss in cold CRPS. Although CRPS diagnosed using the Budapest criteria (24 studies) vs 1994 IASP criteria (13 studies) showed similar sensory profiles, there was significant heterogeneity and low quality of evidence in the latter. CONCLUSIONS Based on the findings of this review, classifying CRPS according to presence or absence of nerve lesion into CRPS-I and II, location (upper or lower limb) or according to sex might not be clinically relevant as all appear to have comparable sensory profiles that might suggest similar underlying mechanisms. In contrast, warm vs cold phenotypes exhibited clear differences in their associated QST sensory profiles. To the extent that differences in underlying mechanisms might lead to differential treatment responsiveness, it appears unlikely that CRPS-I vs II, CRPS location, or patient sex would prove useful in guiding clinical management.
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Affiliation(s)
- Mohamed Gomaa Sobeeh
- Department of Physical Therapy for Musculoskeletal Disorders and its Surgery, Faculty of Physical Therapy, Cairo University, Giza, Egypt
- Department of Physical Therapy for Orthopedic and orthopedic surgery, Faculty of Physical Therapy, Sinai University, Ismailia, Egypt
| | - Karima Abdelaty Hassan
- Department of Physical Therapy for Musculoskeletal Disorders and its Surgery, Faculty of Physical Therapy, Cairo University, Giza, Egypt
| | - Anabela G Silva
- CINTESIS.UA@RISE, School of Health Sciences, University of Aveiro, Aveiro, Portugal
| | - Stephen Bruehl
- Vanderbilt University Medical Center, Nashville, TN, United States
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Amaya-Rodriguez CA, Carvajal-Zamorano K, Bustos D, Alegría-Arcos M, Castillo K. A journey from molecule to physiology and in silico tools for drug discovery targeting the transient receptor potential vanilloid type 1 (TRPV1) channel. Front Pharmacol 2024; 14:1251061. [PMID: 38328578 PMCID: PMC10847257 DOI: 10.3389/fphar.2023.1251061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 12/14/2023] [Indexed: 02/09/2024] Open
Abstract
The heat and capsaicin receptor TRPV1 channel is widely expressed in nerve terminals of dorsal root ganglia (DRGs) and trigeminal ganglia innervating the body and face, respectively, as well as in other tissues and organs including central nervous system. The TRPV1 channel is a versatile receptor that detects harmful heat, pain, and various internal and external ligands. Hence, it operates as a polymodal sensory channel. Many pathological conditions including neuroinflammation, cancer, psychiatric disorders, and pathological pain, are linked to the abnormal functioning of the TRPV1 in peripheral tissues. Intense biomedical research is underway to discover compounds that can modulate the channel and provide pain relief. The molecular mechanisms underlying temperature sensing remain largely unknown, although they are closely linked to pain transduction. Prolonged exposure to capsaicin generates analgesia, hence numerous capsaicin analogs have been developed to discover efficient analgesics for pain relief. The emergence of in silico tools offered significant techniques for molecular modeling and machine learning algorithms to indentify druggable sites in the channel and for repositioning of current drugs aimed at TRPV1. Here we recapitulate the physiological and pathophysiological functions of the TRPV1 channel, including structural models obtained through cryo-EM, pharmacological compounds tested on TRPV1, and the in silico tools for drug discovery and repositioning.
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Affiliation(s)
- Cesar A. Amaya-Rodriguez
- Centro Interdisciplinario de Neurociencia de Valparaíso, Facultad de Ciencias, Universidad de Valparaíso, Valparaíso, Chile
- Departamento de Fisiología y Comportamiento Animal, Facultad de Ciencias Naturales, Exactas y Tecnología, Universidad de Panamá, Ciudad de Panamá, Panamá
| | - Karina Carvajal-Zamorano
- Centro Interdisciplinario de Neurociencia de Valparaíso, Facultad de Ciencias, Universidad de Valparaíso, Valparaíso, Chile
| | - Daniel Bustos
- Centro de Investigación de Estudios Avanzados del Maule (CIEAM), Vicerrectoría de Investigación y Postgrado Universidad Católica del Maule, Talca, Chile
- Laboratorio de Bioinformática y Química Computacional, Departamento de Medicina Traslacional, Facultad de Medicina, Universidad Católica del Maule, Talca, Chile
| | - Melissa Alegría-Arcos
- Núcleo de Investigación en Data Science, Facultad de Ingeniería y Negocios, Universidad de las Américas, Santiago, Chile
| | - Karen Castillo
- Centro Interdisciplinario de Neurociencia de Valparaíso, Facultad de Ciencias, Universidad de Valparaíso, Valparaíso, Chile
- Centro de Investigación de Estudios Avanzados del Maule (CIEAM), Vicerrectoría de Investigación y Postgrado Universidad Católica del Maule, Talca, Chile
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Mangnus TJP, Dirckx M, Huygen FJPM. Different Types of Pain in Complex Regional Pain Syndrome Require a Personalized Treatment Strategy. J Pain Res 2023; 16:4379-4391. [PMID: 38162406 PMCID: PMC10757771 DOI: 10.2147/jpr.s432209] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Accepted: 11/13/2023] [Indexed: 01/03/2024] Open
Abstract
Complex regional pain syndrome (CRPS) is a debilitating painful state of an extremity that can develop after trauma. CRPS is diagnosed by the new International Association for the Study of Pain (IASP) diagnostic criteria for CRPS. The syndrome is characterized by continuing regional pain with abnormal sensory, motor, sudomotor, vasomotor, edema, and/or trophic signs. The clinical presentation of CRPS can be very heterogeneous because CRPS is a multi-mechanism syndrome. Therefore, mechanism-based subgroups have been suggested to personalize treatment for CRPS. Additionally, the presentation of symptom pain may also be able to identify different subgroups of CRPS. In this review, the types of pain recognized by the IASP-nociceptive, neuropathic, and nociplastic pain-will be discussed as possible subgroups for CRPS. Each pain type should be identified in CRPS patients, with a thorough history taking, physical examination, and diagnostic tests or (novel) biomarkers to optimize treatment effectiveness. Over the course of the syndrome, patients with CRPS probably experience more than one distinct pain type. Therefore, pain specialists should be alert to not only adjust their treatment if underlying pathophysiologic mechanisms tend to change but also to personalize the treatment of the associated type of pain in the CRPS patient.
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Affiliation(s)
- Thomas J P Mangnus
- Department of Anesthesiology, Center for Pain Medicine, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Maaike Dirckx
- Department of Anesthesiology, Center for Pain Medicine, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Frank J P M Huygen
- Department of Anesthesiology, Center for Pain Medicine, Erasmus MC University Medical Center, Rotterdam, the Netherlands
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Wen B, Pan Y, Cheng J, Xu L, Xu J. The Role of Neuroinflammation in Complex Regional Pain Syndrome: A Comprehensive Review. J Pain Res 2023; 16:3061-3073. [PMID: 37701560 PMCID: PMC10493102 DOI: 10.2147/jpr.s423733] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 08/26/2023] [Indexed: 09/14/2023] Open
Abstract
Complex Regional Pain Syndrome (CRPS) is an excess and/or prolonged pain and inflammation condition that follows an injury to a limb. The pathogenesis of CRPS is multifaceted that remains incompletely understood. Neuroinflammation is an inflammatory response in the peripheral and central nervous systems. Dysregulated neuroinflammation plays a crucial role in the initiation and maintenance of pain and nociceptive neuronal sensitization, which may contribute to the transition from acute to chronic pain and the perpetuation of chronic pain in CRPS. The key features of neuroinflammation encompass infiltration and activation of inflammatory cells and the production of inflammatory mediators in both the central and peripheral nervous systems. This article reviews the role of neuroinflammation in the onset and progression of CRPS from six perspectives: neurogenic inflammation, neuropeptides, glial cells, immune cells, cytokines, and keratinocytes. The objective is to provide insights that can inform future research and development of therapeutic targets for CRPS.
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Affiliation(s)
- Bei Wen
- Department of Anesthesiology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, People’s Republic of China
| | - Yinbing Pan
- Department of Anesthesiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, People’s Republic of China
| | - Jianguo Cheng
- Department of Pain Management, Cleveland Clinic, Cleveland, OH, 44195, USA
- Department of Neuroscience, Cleveland Clinic, Cleveland, OH, 44195, USA
| | - Li Xu
- Department of Anesthesiology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, People’s Republic of China
| | - Jijun Xu
- Department of Pain Management, Cleveland Clinic, Cleveland, OH, 44195, USA
- Department of Inflammation and Immunity; Cleveland Clinic, Cleveland, OH, 44195, USA
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Harnik MA, Kesselring P, Ott A, Urman RD, Luedi MM. Complex Regional Pain Syndrome (CRPS) and the Value of Early Detection. Curr Pain Headache Rep 2023; 27:417-427. [PMID: 37410335 PMCID: PMC10462545 DOI: 10.1007/s11916-023-01124-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/07/2023] [Indexed: 07/07/2023]
Abstract
PURPOSE OF REVIEW The goal of this narrative review is to describe the current understanding of the pathology of Complex Regional Pain Syndrome (CRPS), as well as diagnostic standards and therapeutic options. We will then make the case for early recognition and management. RECENT FINDINGS CRPS remains an enigmatic pain syndrome, comprising several subtypes. Recent recommendations clarify diagnostic ambiguities and emphasize the importance of standardized assessment and therapy. Awareness of CRPS should be raised to promote prevention, early detection, and rapid escalation of therapy in refractory cases. Comorbidities and health costs (i.e., the socioeconomic impact) must also be addressed early to prevent negative consequences for patients.
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Affiliation(s)
- Michael Alexander Harnik
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Pascal Kesselring
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Alexander Ott
- Department of Anaesthesiology and Pain Medicine, Cantonal Hospital of St. Gallen, St. Gallen, Switzerland
| | - Richard D. Urman
- Department of Anaesthesiology, College of Medicine, The Ohio State University, Columbus, OH 43210 USA
| | - Markus M. Luedi
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Department of Anaesthesiology and Pain Medicine, Cantonal Hospital of St. Gallen, St. Gallen, Switzerland
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Álvarez-Herms J, González A, Corbi F, Odriozola I, Odriozola A. Possible relationship between the gut leaky syndrome and musculoskeletal injuries: the important role of gut microbiota as indirect modulator. AIMS Public Health 2023; 10:710-738. [PMID: 37842270 PMCID: PMC10567981 DOI: 10.3934/publichealth.2023049] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 08/03/2023] [Accepted: 08/07/2023] [Indexed: 10/17/2023] Open
Abstract
This article aims to examine the evidence on the relationship between gut microbiota (GM), leaky gut syndrome and musculoskeletal injuries. Musculoskeletal injuries can significantly impair athletic performance, overall health, and quality of life. Emerging evidence suggests that the state of the gut microbiota and the functional intestinal permeability may contribute to injury recovery. Since 2007, a growing field of research has supported the idea that GM exerts an essential role maintaining intestinal homeostasis and organic and systemic health. Leaky gut syndrome is an acquired condition where the intestinal permeability is impaired, and different bacteria and/or toxins enter in the bloodstream, thereby promoting systemic endotoxemia and chronic low-grade inflammation. This systemic condition could indirectly contribute to increased local musculoskeletal inflammation and chronificate injuries and pain, thereby reducing recovery-time and limiting sport performance. Different strategies, including a healthy diet and the intake of pre/probiotics, may contribute to improving and/or restoring gut health, thereby modulating both systemically as local inflammation and pain. Here, we sought to identify critical factors and potential strategies that could positively improve gut microbiota and intestinal health, and reduce the risk of musculoskeletal injuries and its recovery-time and pain. In conclusion, recent evidences indicate that improving gut health has indirect consequences on the musculoskeletal tissue homeostasis and recovery through the direct modulation of systemic inflammation, the immune response and the nociceptive pain.
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Affiliation(s)
- Jesús Álvarez-Herms
- Department of Genetics, Physical Anthropology and Animal Physiology, University of the Basque Country UPV/EHU, 48080 Leioa, Spain
- Phymo Lab, Physiology, and Molecular laboratory, Spain
| | - Adriana González
- Department of Genetics, Physical Anthropology and Animal Physiology, University of the Basque Country UPV/EHU, 48080 Leioa, Spain
| | - Francisco Corbi
- Institut Nacional d'Educació Física de Catalunya (INEFC), Centre de Lleida, Universitat de Lleida (UdL), Lleida, Spain
| | - Iñaki Odriozola
- Health Department of Basque Government, Donostia-San Sebastián, Spain
| | - Adrian Odriozola
- Department of Genetics, Physical Anthropology and Animal Physiology, University of the Basque Country UPV/EHU, 48080 Leioa, Spain
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De Schoenmacker I, Mollo A, Scheuren PS, Sirucek L, Brunner F, Schweinhardt P, Curt A, Rosner J, Hubli M. Central sensitization in CRPS patients with widespread pain: a cross-sectional study. PAIN MEDICINE (MALDEN, MASS.) 2023; 24:974-984. [PMID: 36946277 PMCID: PMC10391588 DOI: 10.1093/pm/pnad040] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 03/08/2023] [Accepted: 03/20/2023] [Indexed: 03/23/2023]
Abstract
OBJECTIVE Widespread pain hypersensitivity and enhanced temporal summation of pain (TSP) are commonly reported in patients with complex regional pain syndrome (CRPS) and discussed as proxies for central sensitization. This study aimed to directly relate such signs of neuronal hyperexcitability to the pain phenotype of CRPS patients. METHODS Twenty-one CRPS patients and 20 healthy controls (HC) were recruited. The pain phenotype including spatial pain extent (assessed in % body surface) and intensity were assessed and related to widespread pain hypersensitivity, TSP, and psychological factors. Quantitative sensory testing (QST) was performed in the affected, the contralateral and a remote (control) area. RESULTS CRPS patients showed decreased pressure pain thresholds in all tested areas (affected: t(34) = 4.98, P < .001, contralateral: t(35) = 3.19, P = .005, control: t(31) = 2.65, P = .012). Additionally, patients showed increased TSP in the affected area (F(3,111) = 4.57, P = .009) compared to HC. TSP was even more enhanced in patients with a high compared to a low spatial pain extent (F(3,51) = 5.67, P = .008), suggesting pronounced spinal sensitization in patients with extended pain patterns. Furthermore, the spatial pain extent positively correlated with the Bath Body Perception Disturbance Scale (ρ = 0.491; P = .048). CONCLUSIONS Overall, we provide evidence that the pain phenotype in CRPS, that is, spatial pain extent, might be related to sensitization mechanism within the central nociceptive system. This study points towards central neuronal excitability as a potential therapeutic target in patients with more widespread CRPS.
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Affiliation(s)
- Iara De Schoenmacker
- Spinal Cord Injury Center, Balgrist University Hospital, University of Zurich, 8008 Zurich, Switzerland
| | - Anna Mollo
- Spinal Cord Injury Center, Balgrist University Hospital, University of Zurich, 8008 Zurich, Switzerland
| | - Paulina Simonne Scheuren
- Spinal Cord Injury Center, Balgrist University Hospital, University of Zurich, 8008 Zurich, Switzerland
| | - Laura Sirucek
- Integrative Spinal Research, Department of Chiropractic Medicine, University Hospital Balgrist, University of Zurich, 8008 Zurich, Switzerland
| | - Florian Brunner
- Physical Medicine and Rheumatology, Balgrist University Hospital, 8008 Zurich, Switzerland
| | - Petra Schweinhardt
- Integrative Spinal Research, Department of Chiropractic Medicine, University Hospital Balgrist, University of Zurich, 8008 Zurich, Switzerland
- Alan Edward Center for Research on Pain, McGill University, Montreal, Quebec, Canada
| | - Armin Curt
- Spinal Cord Injury Center, Balgrist University Hospital, University of Zurich, 8008 Zurich, Switzerland
| | - Jan Rosner
- Spinal Cord Injury Center, Balgrist University Hospital, University of Zurich, 8008 Zurich, Switzerland
- Department of Neurology, University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Michèle Hubli
- Spinal Cord Injury Center, Balgrist University Hospital, University of Zurich, 8008 Zurich, Switzerland
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Ratcliffe S, Arkilo D, Asgharnejad M, Bhattacharya S, Harden RN. Randomized controlled study to evaluate the efficacy and safety of soticlestat as adjunctive therapy in adults with complex regional pain syndrome. PAIN MEDICINE (MALDEN, MASS.) 2023; 24:872-880. [PMID: 36538782 PMCID: PMC10321763 DOI: 10.1093/pm/pnac198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 12/02/2022] [Accepted: 12/06/2022] [Indexed: 07/20/2023]
Abstract
OBJECTIVE The objective was to investigate the efficacy and safety of soticlestat as adjunctive therapy in participants with complex regional pain syndrome (CRPS). DESIGN A proof-of-concept phase 2a study, comprising a 15-week randomized, double-blind, placebo-controlled, parallel-group study (part A), and an optional 14-week open-label extension (part B). METHODS Twenty-four participants (median age 44.5 years [range, 18-62 years]; 70.8% female) with chronic CRPS were randomized (2:1) to receive oral soticlestat or placebo. Soticlestat dosing started at 100 mg twice daily and was titrated up to 300 mg twice daily. In part B, soticlestat dosing started at 200 mg twice daily and was titrated up or down at the investigator's discretion. Pain intensity scores using the 11-point Numeric Pain Scale (NPS) were collected daily. The Patient-Reported Outcomes Measurement Information System (PROMIS)-29, Patients' Global Impression of Change (PGI-C), and CRPS Severity Score (CSS) were completed at screening and weeks 15 and 29. RESULTS From baseline to week 15, soticlestat treatment was associated with a mean change in 24-hour pain intensity NPS score (95% confidence interval) of -0.75 (-1.55, 0.05) vs -0.41 (-1.41, 0.59) in the placebo group, resulting in a non-significant placebo-adjusted difference of -0.34 (-1.55, 0.88; P = .570). Statistically non-significant numerical changes were observed for the PROMIS-29, PGI-C, and CSS at weeks 15 and 29. CONCLUSIONS Adjunctive soticlestat treatment did not significantly reduce pain intensity in participants with chronic CRPS.
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Affiliation(s)
| | - Dimitrios Arkilo
- Takeda Pharmaceutical Company Limited, Cambridge, MA 02139, United States
| | - Mahnaz Asgharnejad
- Takeda Pharmaceutical Company Limited, Cambridge, MA 02139, United States
| | | | - R Norman Harden
- Departments of Physical Medicine and Rehabilitation and Physical Therapy and Human Movement Science, , Northwestern University Feinberg School of Medicine, Chicago, IL 60611, United States
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Sobeeh MG, Hassan KA, da Silva AG, Youssef EF, Fayaz NA, Mohammed MM. Pain mechanisms in complex regional pain syndrome: a systematic review and meta-analysis of quantitative sensory testing outcomes. J Orthop Surg Res 2023; 18:2. [PMID: 36593515 PMCID: PMC9806919 DOI: 10.1186/s13018-022-03461-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 12/19/2022] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Complex regional pain syndrome (CRPS) is a chronic condition following inciting events such as fractures or surgeries with sensorimotor and autonomic manifestations and poor prognosis. This review aimed to provide conclusive evidence about the sensory phenotype of CRPS based on quantitative sensory testing (QST) to understand the underlying pain mechanisms and guide treatment strategies. DATABASES Eight databases were searched based on a previously published protocol. Forty studies comparing QST outcomes (thermal, mechanical, vibration, and electric detection thresholds, thermal, mechanical, pressure, and electric pain thresholds, wind-up ratio, mechanical pain sensitivity, allodynia, flare area, area after pinprick hyperalgesia, pleasantness after C-tactile stimulation, and pain ratings) in chronic CRPS (adults and children) versus healthy controls were included. RESULTS From 37 studies (14 of low quality, 22 of fair quality, and 1 of good quality), adults with CRPS showed: (i) significant loss of thermal, mechanical, and vibration sensations, significant gain of thermal and mechanical pain thresholds, significant elevation of pain ratings, and no difference in wind-up ratio; (ii) significant reduction of pleasantness levels and increased area of pinprick hyperalgesia, in the affected limb. From three fair-quality studies, adolescents and children with CRPS showed loss of cold detection with cold hyperalgesia in the affected limb. There was moderate to substantial overall heterogeneity. CONCLUSION Diffuse thermal and mechanical hypoesthesia with primary and secondary hyperalgesia, enhanced pain facilitation evidenced by increased area of pinprick hyperalgesia, and elevated pain ratings are dominant in adults with CRPS. Adolescents and children with CRPS showed less severe sensory abnormalities.
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Affiliation(s)
- Mohamed Gomaa Sobeeh
- grid.7776.10000 0004 0639 9286Department of Physical Therapy for Musculoskeletal Disorders and its Surgeries, Faculty of Physical Therapy, Cairo University, Giza, Egypt ,grid.442728.f0000 0004 5897 8474Faculty of Physical Therapy, Sinai University, Ismailia, Egypt
| | - Karima Abdelaty Hassan
- grid.7776.10000 0004 0639 9286Department of Physical Therapy for Musculoskeletal Disorders and its Surgeries, Faculty of Physical Therapy, Cairo University, Giza, Egypt
| | - Anabela Gonçalves da Silva
- grid.7311.40000000123236065CINTESIS.UA@RISE, School of Health Sciences, University of Aveiro, Aveiro, Portugal
| | - Enas Fawzy Youssef
- grid.7776.10000 0004 0639 9286Department of Physical Therapy for Musculoskeletal Disorders and its Surgeries, Faculty of Physical Therapy, Cairo University, Giza, Egypt
| | - Nadia Abdelazim Fayaz
- grid.7776.10000 0004 0639 9286Department of Physical Therapy for Musculoskeletal Disorders and its Surgeries, Faculty of Physical Therapy, Cairo University, Giza, Egypt
| | - Maha Mostafa Mohammed
- grid.7776.10000 0004 0639 9286Department of Physical Therapy for Musculoskeletal Disorders and its Surgeries, Faculty of Physical Therapy, Cairo University, Giza, Egypt
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Saba EKA. Efficacy of neural prolotherapy in treatment of meralgia paresthetica: a case series. EGYPTIAN JOURNAL OF NEUROSURGERY 2022. [DOI: 10.1186/s41984-022-00160-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Meralgia paresthetica is an entrapment neuropathy. Neuropathic pain was reported to be improved by using neural prolotherapy. Aim of the research was to assess and evaluate the short-term efficacy of neural prolotherapy on relieving pain, paresthesia and improving function and quality of life of patients with meralgia paresthetica. The study included 19 lower limbs with idiopathic meralgia paresthetica obtained from 15 patients. Subcutaneous perineural injection of dextrose (5%) in sterile water was given once. All patients were evaluated for outcome measures twice, at baseline visit and at follow-up visit four weeks after the injection which included: patient assessment of overall symptoms of meralgia paresthetica, patient assessment of meralgia paresthetica pain, patient assessment of meralgia paresthetica paresthesia and patient assessment of meralgia paresthetica effect on function and quality of life using visual analogue scale.
Results
There was a statistically significant improvement in the visual analogue scale of patient assessment of overall meralgia paresthetica symptoms, patient assessment of meralgia paresthetica pain, patient assessment of meralgia paresthetica paresthesia and patient assessment of meralgia paresthetica effect on function and quality of life when the findings at the postinjection visit were compared to the preinjection assessment among all patients. All the patients tolerated the injection procedure-induced pain. All the patients experienced immediate postinjection relieve of the meralgia paresthetica pain. At the postinjection assessment visit, all patients were satisfied with the procedure. There were 12 lower limbs (63.2%) from 10 patients (66.6%) that showed improvement and recovery. Two patients of them had bilateral meralgia paresthetica. There was no patient withdrawal, and no patients were lost to follow-up. There was one lower limb (5.3%) from one patient (6.7%) who had bruises at the injection sites that resolved within few days after the procedure.
Conclusions
Neural prolotherapy is easy, safe, tolerable, effective and successful in treatment of meralgia paresthetica. It is effective in relieving pain, paresthesia and improving function and quality of life of patients with meralgia paresthetica. Neural prolotherapy injection should be included in the conservative treatment armamentarium of meralgia paresthetica.
Trial registration : NCT04499911. Registered 5 August 2020—retrospectively registered.
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Al-Qubaisi MS, Al-Abboodi AS, Alhassan FH, Hussein-Al-Ali S, Flaifel MH, Eid EE, Alshwyeh HA, Hussein MZ, Alnasser SM, Saeed MI, Rasedee A, Ibrahim WN. Preparation, characterization, in vitro drug release and anti-inflammatory of thymoquinone-loaded chitosan nanocomposite. Saudi Pharm J 2022; 30:347-358. [PMID: 35527823 PMCID: PMC9068746 DOI: 10.1016/j.jsps.2022.02.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Accepted: 02/02/2022] [Indexed: 11/21/2022] Open
Abstract
In this study, we formulated Thymoquinone-loaded nanocomposites (TQ-NCs) using high-pressure homogenizer without sodium tripolyphosphate. The TQ-NCs were characterized and their anti-inflammatory determined by the response of the LPS-stimulated macrophage RAW 264.7 cells in the production of nitric oxide, prostaglandin E2, tumor necrosis factor-α, interleukin-6, and interleukin-1β. The physicochemical properties of TQ-NC were determined using different machines. TQ was fully incorporated in the highly thermal stable nanoparticles. The nanoparticles showed rapid release of TQ in the acidic medium of the gastric juice. In medium of pH 6.8, TQ-NC exhibited sustained release of TQ over a period of 100 h. The results suggest that TQ-NC nanoparticles have potential application as parenterally administered therapeutic compound. TQ-NC effectively reduce production of inflammatory cytokines by the LPS-stimulated RAW 264.7 cells, indicating that they have anti-inflammatory properties. In conclusion, TQ-NC nanoparticles have the characteristics of efficient carrier for TQ and an effective anti-inflammatory therapeutic compound.
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Affiliation(s)
| | | | - Fatah H. Alhassan
- Department of Applied Chemistry and Technology, College of Science and Arts, Alkamel University of Jeddah, Jeddah 21589, Saudi Arabia
| | | | - Moayad Husein Flaifel
- Department of Physics, College of Science, Imam Abdulrahman Bin Faisal University, Dammam 31441, Saudi Arabia
- Basic & Applied Scientific Research Center, College of Science, Imam Abdulrahman Bin Faisal University, Dammam 31441, Saudi Arabia
| | - Eltayeb E.M. Eid
- Department of Pharmaceutical Chemistry and Pharmacognosy, Unaizah College of Pharmacy, Qassim University, Saudi Arabia
| | - Hussah Abdullah Alshwyeh
- Basic & Applied Scientific Research Center, College of Science, Imam Abdulrahman Bin Faisal University, Dammam 31441, Saudi Arabia
- Department of Biology, College of Science, Imam Abdulrahman Bin Faisal University, Dammam 31441, Saudi Arabia
| | - Mohd Zobir Hussein
- Department of Chemistry, Faculty of Science, Universiti Putra Malaysia, 43400 UPM Serdang, Selangor, Malaysia
| | | | - Mohammed Ibrahim Saeed
- Faculty of Medical Laboratory Sciences, National Ribat University, Khartoum 11111, Sudan
| | - Abdullah Rasedee
- Institute of Bioscience, Universiti Putra Malaysia, 43400 UPM Serdang, Selangor, Malaysia
- Department of Veterinary Pathology and Microbiology, Faculty of Veterinary Medicine, Universiti Putra Malaysia, 43400 UPM Serdang, Selangor, Malaysia
| | - Wisam Nabeel Ibrahim
- Department of Biomedical Science, College of Health Sciences, QU Health, Qatar University, Doha, Qatar
- Biomedical and Pharmaceutical Research Unit, QU Health, Qatar University, Doha, Qatar
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From a Symptom-Based to a Mechanism-Based Pharmacotherapeutic Treatment in Complex Regional Pain Syndrome. Drugs 2022; 82:511-531. [PMID: 35247200 PMCID: PMC9016036 DOI: 10.1007/s40265-022-01685-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2022] [Indexed: 02/06/2023]
Abstract
Complex regional pain syndrome (CRPS) is a debilitating painful condition of a distal extremity that can develop after tissue damage. CRPS is thought to be a multimechanism syndrome and ideally the most prominent mechanism(s) should be targeted by drugs in an individually tailored manner. This review gives an overview of the action and evidence of current and future pharmacotherapeutic options for CRPS. The available options are grouped in four categories by their therapeutic actions on the CRPS mechanisms, i.e. inflammation, central sensitisation, vasomotor disturbances and motor disturbances. More knowledge about the underlying mechanisms of CRPS helps to specifically target important CRPS mechanisms. In the future, objective biomarkers could potentially aid in selecting appropriate mechanism-based drugs in order to increase the effectiveness of CRPS treatment. Using this approach, current and future pharmacotherapeutic options for CRPS should be studied in multicentre trials to prove their efficacy. The ultimate goal is to shift the symptom-based selection of therapy into a mechanism-based selection of therapy in CRPS.
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Acosta-Olivo C, Simental-Mendía LE, Vilchez-Cavazos F, Peña-Martínez VM, Elizondo-Rodíguez J, Simental-Mendía M. Clinical Efficacy of Botulinum Toxin in the Treatment of Plantar Fasciitis: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Arch Phys Med Rehabil 2021; 103:364-371.e2. [PMID: 34688605 DOI: 10.1016/j.apmr.2021.10.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 09/24/2021] [Accepted: 10/01/2021] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To evaluate the efficacy of botulinum toxin A (BTX-A) for the treatment of plantar fasciitis through a meta-analysis of randomized controlled trials (RCTs) focusing on pain and functional outcomes since current literature has supported a potential benefit of BTX-A. DATA SOURCES The MEDLINE, EMBASE, Web of Science, and Scopus databases were searched until December 2020 for RCTs reporting the effects of BTX-A injections on plantar fasciitis. The complementary literature search included Cochrane Central Register of Controlled Trials, Clinicaltrials.gov, and greylit.org. STUDY SELECTION Only RCTs assessing the effect of BTX-A injections on pain, functional improvement, or plantar fascia thickness in patients with plantar fasciitis were included. Multiple researchers carried out the screening process of the 413 records. DATA EXTRACTION Data were extracted independently and in duplicate using a standardized data extraction format. Information was contrasted by a third observer. DATA SYNTHESIS BTX-A injections resulted in significant pain relief (mean difference, -2.07 [95% CI, -3.21 to -0.93]; P=.0004; I2=97%) and functional improvement (standardized mean difference, 1.15 [95% CI, 0.39-1.91]; P=.003; I2=87%). A subanalysis indicated that pain relief was sustained at 12 months while functional improvement remained significant after 0-6 months. The results were not affected by a single study after sensitivity analysis. The site of injection and the use or not of ultrasound-guided injections may account for potential sources of interstudy heterogeneity. CONCLUSIONS This meta-analysis suggests both a statistically significant and a clinically meaningful improvement on plantar fasciitis symptoms after BTX-A treatment.
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Affiliation(s)
- Carlos Acosta-Olivo
- Universidad Autónoma de Nuevo León, Orthopedics and Traumatology Service, Hospital Universitario "Dr José Eleuterio González," School of Medicine, Monterrey, México
| | - Luis E Simental-Mendía
- Instituto Mexicano del Seguro Social, Unidad de Investigación Biomédica, Delegación Durango, Durango, México
| | - Félix Vilchez-Cavazos
- Universidad Autónoma de Nuevo León, Orthopedics and Traumatology Service, Hospital Universitario "Dr José Eleuterio González," School of Medicine, Monterrey, México
| | - Víctor M Peña-Martínez
- Universidad Autónoma de Nuevo León, Orthopedics and Traumatology Service, Hospital Universitario "Dr José Eleuterio González," School of Medicine, Monterrey, México
| | - Jorge Elizondo-Rodíguez
- Universidad Autónoma de Nuevo León, Orthopedics and Traumatology Service, Hospital Universitario "Dr José Eleuterio González," School of Medicine, Monterrey, México
| | - Mario Simental-Mendía
- Universidad Autónoma de Nuevo León, Orthopedics and Traumatology Service, Hospital Universitario "Dr José Eleuterio González," School of Medicine, Monterrey, México.
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15
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Zangrandi A, Allen Demers F, Schneider C. Complex Regional Pain Syndrome. A Comprehensive Review on Neuroplastic Changes Supporting the Use of Non-invasive Neurostimulation in Clinical Settings. FRONTIERS IN PAIN RESEARCH 2021; 2:732343. [PMID: 35295500 PMCID: PMC8915550 DOI: 10.3389/fpain.2021.732343] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 08/23/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Complex regional pain syndrome (CRPS) is a rare debilitating disorder characterized by severe pain affecting one or more limbs. CRPS presents a complex multifactorial physiopathology. The peripheral and sensorimotor abnormalities reflect maladaptive changes of the central nervous system. These changes of volume, connectivity, activation, metabolism, etc., could be the keys to understand chronicization, refractoriness to conventional treatment, and developing more efficient treatments. Objective: This review discusses the use of non-pharmacological, non-invasive neurostimulation techniques in CRPS, with regard to the CRPS physiopathology, brain changes underlying chronicization, conventional approaches to treat CRPS, current evidence, and mechanisms of action of peripheral and brain stimulation. Conclusion: Future work is warranted to foster the evidence of the efficacy of non-invasive neurostimulation in CRPS. It seems that the approach has to be individualized owing to the integrity of the brain and corticospinal function. Non-invasive neurostimulation of the brain or of nerve/muscles/spinal roots, alone or in combination with conventional therapy, represents a fertile ground to develop more efficient approaches for pain management in CRPS.
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Affiliation(s)
- Andrea Zangrandi
- Noninvasive Neurostimulation Laboratory (NovaStim), Quebec City, QC, Canada
- Neuroscience Division of Centre de Recherche du CHU of Québec, Université Laval, Quebec City, QC, Canada
- Faculty of Medicine, Université Laval, Quebec City, QC, Canada
| | - Fannie Allen Demers
- Noninvasive Neurostimulation Laboratory (NovaStim), Quebec City, QC, Canada
- Neuroscience Division of Centre de Recherche du CHU of Québec, Université Laval, Quebec City, QC, Canada
- Faculty of Medicine, Université Laval, Quebec City, QC, Canada
| | - Cyril Schneider
- Noninvasive Neurostimulation Laboratory (NovaStim), Quebec City, QC, Canada
- Neuroscience Division of Centre de Recherche du CHU of Québec, Université Laval, Quebec City, QC, Canada
- Faculty of Medicine, Université Laval, Quebec City, QC, Canada
- Department Rehabilitation, Université Laval, Quebec City, QC, Canada
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Moretti A, Gimigliano F, Paoletta M, Bertone M, Liguori S, Toro G, Iolascon G. Complex Regional Pain Syndrome Type I Following Non-Orthopedic Surgery: Case Report and Narrative Review. Diagnostics (Basel) 2021; 11:diagnostics11091596. [PMID: 34573938 PMCID: PMC8465880 DOI: 10.3390/diagnostics11091596] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 08/30/2021] [Accepted: 08/30/2021] [Indexed: 02/05/2023] Open
Abstract
Complex regional pain syndrome type I (CRPS I)-or algodystrophy-is a rare disease that usually occurs after a traumatic event. It is characterized by typical clinical findings such as severe and disabling pain disproportionate to the injury, functional limitations, as well as sensory and vasomotor alterations. However, some people do not report any injury associated with algodystrophy onset in personal history. We describe the management of an unusual case of CRPS I which occurred during the long-term follow-up of percutaneous transluminal coronary angioplasty (PTCA) and performed a narrative review of algodystrophy in non-orthopedic surgery. A clinical case of a 44-year-old man with a spontaneous onset of CRPS I of the right ankle is presented. He did not refer to history of any memorable significant trigger event. Approximately 5 months before the onset of clinical manifestations, he received a PTCA via the right femoral approach. We suppose an association between CRPS and this procedure and propose a possible pathophysiologic mechanism. The patient was treated with intramuscular neridronate, which resulted in significant pain relief and improved his quality of life. A comprehensive clinical and instrumental evaluation in patients with CRPS is challenging but mandatory for a correct diagnosis. An extensive analysis of patient history is important for identifying any potential trigger event, including non-orthopedic procedures. Bone scan could have a pivotal role for improving diagnostic sensitivity and specificity in CRPS I. Neridronate was a safe and effective therapeutic approach for this patient, confirming the results of the high-quality evidence available.
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Affiliation(s)
- Antimo Moretti
- Department of Medical and Surgical Specialties and Dentistry, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (A.M.); (M.B.); (S.L.); (G.T.); (G.I.)
| | - Francesca Gimigliano
- Department of Mental and Physical Health and Preventive Medicine, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy;
| | - Marco Paoletta
- Department of Medical and Surgical Specialties and Dentistry, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (A.M.); (M.B.); (S.L.); (G.T.); (G.I.)
- Correspondence:
| | - Matteo Bertone
- Department of Medical and Surgical Specialties and Dentistry, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (A.M.); (M.B.); (S.L.); (G.T.); (G.I.)
| | - Sara Liguori
- Department of Medical and Surgical Specialties and Dentistry, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (A.M.); (M.B.); (S.L.); (G.T.); (G.I.)
| | - Giuseppe Toro
- Department of Medical and Surgical Specialties and Dentistry, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (A.M.); (M.B.); (S.L.); (G.T.); (G.I.)
| | - Giovanni Iolascon
- Department of Medical and Surgical Specialties and Dentistry, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (A.M.); (M.B.); (S.L.); (G.T.); (G.I.)
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Experimentally induced spine osteoarthritis in rats leads to neurogenic inflammation within neurosegmentally linked myotomes. Exp Gerontol 2021; 149:111311. [PMID: 33744392 DOI: 10.1016/j.exger.2021.111311] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 09/13/2020] [Accepted: 03/04/2021] [Indexed: 12/19/2022]
Abstract
Naturally occurring spine osteoarthritis is clinically associated with the manifestation of chronic inflammatory muscle (myofascial) disease. The purpose of this study was to investigate the causal association between experimentally induced spine osteoarthritis and neurogenic inflammatory responses within neurosegmentally linked myotomes. Wistar Kyoto rats were randomly assigned to spine facet compression surgery (L4-L6) or sham surgery. Animals exposed to facet compression surgery demonstrated radiographic signs of facet-osteoarthritis (L4-L6 spinal levels) and sensory changes (allodynia, thermal hyperalgesia) at 7, 14 and 21 days post-intervention, consistent with the induction of central sensitization; no radiologic or sensory changes were observed after sham surgery. Increased levels of proinflammatory biomarkers including substance P (SP), calcitonin gene related peptide (CGRP), protease-activated receptor-2 (PAR2) and calcium/calmodulin dependent protein kinase II (CaMKII) were observed post-surgery within neurosegmentally-linked rectus femoris (L2-L5) muscle when compared to the non-segmentally linked biceps brachii (C4-C7) muscle; no differences were observed between muscles in the sham surgery group. These findings offer novel insight into the potential role of spine osteoarthritis and neurogenic inflammatory mechanisms in the pathophysiology of chronic inflammatory muscle (myofascial) disease.
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18
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Mohiuddin M, Pivetta B, Gilron I, Khan JS. Efficacy and Safety of N-acetylcysteine for the Management of Chronic Pain in Adults: A Systematic Review & Meta-analysis. PAIN MEDICINE 2021; 22:2896-2907. [PMID: 33560443 DOI: 10.1093/pm/pnab042] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To assess the efficacy and safety of N-acetylcysteine in the treatment of chronic pain. METHODS A systematic search was carried out until April 2020 for clinical studies of N-acetylcysteine in the management of any persistent or recurrent chronic pain condition for adults ≥ 18 years old. Risk of Bias was assessed using the validated risk of bias tools. When appropriate, a meta-analysis using a random-effects model was performed, with a fixed-effect model for sensitivity analysis. RESULTS Nine studies (n = 863) were included (5 randomized controlled trials [RCTs], 2 open-label non-comparative studies and 2 comparative studies), that evaluated patients with sickle cell disease (3), complex regional pain syndrome (1), pelvic pain/endometriosis (2), rheumatoid arthritis (1), diabetic neuropathy (1), and chronic neuropathic pain (1). In the pooled analysis of 3 RCTs, N-acetylcysteine did not reduce pain intensities (SMD -0.21, 95% CI -0.33 to 0.75, random-effects), improve functional outcomes (SMD 0.21, 95% CI -0.33 to 0.75) or quality of life (SMD 0.60, 95% CI -4.44 to 5.64); however, sensitivity analysis with a fixed effect model demonstrated an effect for pain intensities and function. Due to adverse events being inconsistently reported, no conclusion could be made regarding safety of N-acetylcysteine in chronic pain. CONCLUSIONS While there is some evidence to indicate N-acetylcysteine may provide analgesic efficacy for certain pain conditions, there is insufficient evidence to provide definitive evidence on NAC in chronic pain management. Larger-size RCTs spanning a variety of chronic pain conditions are needed to determine N-acetylcysteine's role, if any, in pain medicine.
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Affiliation(s)
| | - Bianca Pivetta
- Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Ian Gilron
- Department of Anesthesiology and Perioperative Medicine, Kingston General Hospital, Queen's University Kingston, Canada
| | - James S Khan
- Mount Sinai Hospital, Department of Anesthesia and Pain Medicine, University of Toronto, Toronto, Canada
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Of mice, microglia, and (wo)men: a case series and mechanistic investigation of hydroxychloroquine for complex regional pain syndrome. Pain Rep 2021; 5:e841. [PMID: 33490839 PMCID: PMC7808678 DOI: 10.1097/pr9.0000000000000841] [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: 03/09/2020] [Revised: 06/19/2020] [Accepted: 07/02/2020] [Indexed: 12/27/2022] Open
Abstract
Introduction Complex regional pain syndrome (CRPS) is a condition that occurs after minor trauma characterized by sensory, trophic, and motor changes. Although preclinical studies have demonstrated that CRPS may be driven in part by autoinflammation, clinical use of immune-modulating drugs in CRPS is limited. Hydroxychloroquine (HCQ) is a disease-modifying antirheumatic drug used to treat malaria and autoimmune disorders that may provide benefit in CRPS. Objectives To describe the use of HCQ in patients with refractory CRPS and investigate possible mechanisms of benefit in a mouse model of CRPS. Methods We initiated HCQ therapy in 7 female patients with refractory CRPS undergoing treatment at the Stanford Pain Management Center. We subsequently undertook studies in the mouse tibial fracture-casting model of CRPS to identify mechanisms underlying symptom reduction. We evaluated behavior using mechanical allodynia and spinal cord autoinflammation by immunohistochemistry and enzyme-linked immunosorbent assay. Results We treated 7 female patients with chronic, refractory CRPS with HCQ 200 mg twice daily for 2 months, followed by 200 mg daily thereafter. Two patients stopped HCQ secondary to lack of response or side effects. Overall, HCQ significantly improved average numerical rating scale pain from 6.8 ± 1.1 before HCQ to 3.8 ± 1.9 after HCQ treatment. In the tibial fracture-casting mouse model of CRPS, we observed reductions in allodynia, paw edema, and warmth following daily HCQ treatment starting at 3 weeks after injury. Spinal cord dorsal horn microglial activation and cytokine levels were also reduced by HCQ treatment. Conclusion Together, these preclinical and clinical results suggest that HCQ may benefit patients with CRPS at least in part by modulating autoinflammation and support further investigation into the use of HCQ for CRPS.
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Luddi A, Marrocco C, Governini L, Semplici B, Pavone V, Capaldo A, Tosti C, Greco S, Luisi S, Ciarmela P, Petraglia F, Piomboni P. Increased expression of neurogenic factors in uterine fibroids. Hum Reprod 2020; 34:2153-2162. [PMID: 31732726 DOI: 10.1093/humrep/dez182] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 07/05/2019] [Indexed: 12/18/2022] Open
Abstract
STUDY QUESTION Are selective markers for the neuronal differentiation such as microtubule-associated protein 2 (MAP-2) and synaptophysin (SYP) as well as the nerve growth factor (NGF) expressed by fibroids, myometrium and eutopic endometrium? SUMMARY ANSWER Neuronal markers NGF, MAP-2 and SYP are highly expressed in fibroids compared with matched myometrium, and this neurogenic pathway is upregulated by tumor necrosis factor (TNF) alpha in cultured smooth muscle cells (SMCs). WHAT IS KNOWN ALREADY Uterine fibroids or leiomyomas are the most common benign tumors, accounting for approximately one-third of hysterectomies. The present trend is to improve the medical treatment avoiding surgery, also for fertility sparing; hence, the pathogenic mechanisms are investigated, aiming to develop new therapeutic strategy. STUDY DESIGN, SIZE, DURATION This laboratory-based case-control study is focused on fibroids and myometrial specimens obtained between 2015 and 2017 from 15 women of reproductive age at the proliferative phase of the menstrual cycle. Leiomyomas, matched myometrium and endometrium from each woman were analyzed. Control endometrium was obtained from women undergoing surgery for ovarian cyst (n = 15). PARTICIPANTS/MATERIALS, SETTING, METHODS qRT-PCR, western blotting and immunostaining were applied to evaluate the expression of neurogenic markers; the effects of TNF on NGF, MAP-2 and SYP expression in cultured SMCs from leiomyomas and matched myometrium were analyzed. MAIN RESULTS AND THE ROLE OF CHANCE qRT-PCR analyses using tissues from clinical patients showed that the levels of NGF, MAP-2 and SYP mRNA were significantly higher in uterine leiomyomas compared with their matched myometrium (P < 0.05), whereas only NGF was significantly increased in eutopic endometrium compared with healthy endometrium. In primary SMCs, isolated from fibroids or from the adjacent myometrium, NGF, MAP-2 and SYP mRNA expression were significantly increased by TNF treatment (P < 0.05). Finally, human endometrial stromal cells prepared from the endometrium of patients affected by uterine fibroids display higher TNF expression (P < 0.001). LIMITATIONS, REASONS FOR CAUTION qRT-PCR analysis and immunofluorescence validation are robust methods demonstrating a clear upregulation of neurogenic factors in leiomyomas, even though additional studies are needed to establish a correlation between increased neuronal gene expression and degree of pain, as well as the involvement of inflammation mediators in the development of the neurogenic unhinge. Therefore, more in vivo studies are needed to confirm the results achieved from primary cultured SMCs. WIDER IMPLICATIONS OF THE FINDINGS The increased expression of neurogenic factors in uterine fibroids and endometrium may contribute to explain the painful stimuli. Accordingly, these neurogenic pathways may represent potential therapeutic avenues to treat the fibroid-related disorders. STUDY FUNDING/COMPETING INTEREST(S) This study was supported by research grants from the University of Siena. The authors declare no conflict of interest. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- Alice Luddi
- Dept. of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | - Camilla Marrocco
- Dept. of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | - Laura Governini
- Dept. of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | - Bianca Semplici
- Dept. of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | - Valentina Pavone
- Dept. of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | - Angela Capaldo
- Dept. of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | - Claudia Tosti
- Dept. of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | - Stefania Greco
- Dept. of Experimental and Clinical Medicine, Università Politecnica delle Marche, Ancona, Italy
| | - Stefano Luisi
- Dept. of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | - Pasquapina Ciarmela
- Dept. of Experimental and Clinical Medicine, Università Politecnica delle Marche, Ancona, Italy
| | - Felice Petraglia
- Dept. of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
| | - Paola Piomboni
- Dept. of Molecular and Developmental Medicine, University of Siena, Siena, Italy
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Lee SU, Na KT, Lee YM, Park JH, Joo SY. Low vitamin D levels in post-menopausal women are associated with complex regional pain syndrome type I in surgically treated distal radius fractures. J Orthop Surg Res 2020; 15:328. [PMID: 32795337 PMCID: PMC7427936 DOI: 10.1186/s13018-020-01859-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 08/03/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Complex regional pain syndrome type I (CRPS I) is a chronic devastating condition and a relatively common complication of distal radius fractures (DRF). The purpose of this study was to investigate the relationship of vitamin D levels in surgically treated post-menopausal women with CRPS I occurrence in DRF. METHODS From February 2016 to March 2017, 158 surgically treated post-menopausal patients with DRF were enrolled. Exclusion criteria were (1) patients who had been taking vitamin D or osteoporosis medication at the time of injury; (2) patients with medical factors that may affect vitamin D levels; (3) patients who were reluctant to enroll in the study; and (4) patient with additional fractures, ligamentous injuries, or neuropathy. A total of 107 patients were available for final analysis. We compared the serum vitamin D levels in post-menopausal women with DRF with CRPS I (group 1) and without CRPS I (group 2). Bone mineral density (BMD) of the femur and spine, osteocalcin, alkaline phosphatase (ALP), body mass index (BMI) were also measured. RESULTS The average age at the time of surgery was 66.5 years (range, 39-86 years). The mean follow-up period was 16.3 months after surgery. Among the 107 surgically treated DRF patients, 19 (18%) met the Budapest criteria for CRPS I during the follow-up period. The mean serum vitamin D level in group 1 (15.2 ng/ml) was significantly lower than that in group 2 (20.5 ng/ml, p = 0.027). The mean values of osteocalcin, ALP, BMI, and BMD were not significantly different between the groups. CONCLUSION Lower vitamin D levels in post-menopausal women can increase CRPS I occurrence in distal radius fractures.
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Affiliation(s)
- Sang-Uk Lee
- Department of Orthopedic Surgery, Incheon St. Mary's Hospital, The Catholic University of Korea, 56 Dong-su ro, Bupyeong-gu, Incheon, 21431, Republic of Korea
| | - Ki-Tae Na
- Department of Orthopedic Surgery, Incheon St. Mary's Hospital, The Catholic University of Korea, 56 Dong-su ro, Bupyeong-gu, Incheon, 21431, Republic of Korea
| | - Yoon-Min Lee
- Department of Orthopedic Surgery, Yeouido St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Jong Hwa Park
- Department of Orthopedic Surgery, Incheon St. Mary's Hospital, The Catholic University of Korea, 56 Dong-su ro, Bupyeong-gu, Incheon, 21431, Republic of Korea
| | - Sun Young Joo
- Department of Orthopedic Surgery, Incheon St. Mary's Hospital, The Catholic University of Korea, 56 Dong-su ro, Bupyeong-gu, Incheon, 21431, Republic of Korea.
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22
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Bharwani KD, Dik WA, Dirckx M, Huygen FJPM. Highlighting the Role of Biomarkers of Inflammation in the Diagnosis and Management of Complex Regional Pain Syndrome. Mol Diagn Ther 2020; 23:615-626. [PMID: 31363934 PMCID: PMC6775035 DOI: 10.1007/s40291-019-00417-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Complex regional pain syndrome (CRPS) is characterized by continuous pain that is often accompanied by sensory, motor, vasomotor, sudomotor, and trophic disturbances. If left untreated, it can have a significant impact on the quality of life of patients. The diagnosis of CRPS is currently based on a set of relatively subjective clinical criteria: the New International Association for the Study of Pain clinical diagnostic criteria for CRPS. There are still no objective laboratory tests to diagnose CRPS and there is a great need for simple, objective, and easily measurable biomarkers in the diagnosis and management of this disease. In this review, we discuss the role of inflammation in the multi-mechanism pathophysiology of CRPS and highlight the application of potential biomarkers of inflammation in the diagnosis and management of this disease.
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Affiliation(s)
- Krishna D Bharwani
- Center for Pain Medicine, Department of Anesthesiology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands.
| | - Willem A Dik
- Laboratory Medical Immunology, Department of Immunology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Maaike Dirckx
- Center for Pain Medicine, Department of Anesthesiology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Frank J P M Huygen
- Center for Pain Medicine, Department of Anesthesiology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
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Duarte FCK, Zwambag DP, Brown SHM, Clark A, Hurtig M, Srbely JZ. Increased Substance P Immunoreactivity in Ipsilateral Knee Cartilage of Rats Exposed to Lumbar Spine Injury. Cartilage 2020; 11:251-261. [PMID: 30461296 PMCID: PMC7097978 DOI: 10.1177/1947603518812568] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE The present study aimed to investigate whether experimentally induced lumbar facet-joint OA lead to degenerative changes and enhanced SP expression within the ipsilateral neurosegmentally linked tibiofemoral cartilage. METHODS Adult male Sprague-Dawley rats were assigned to left side L5-L6 facet mechanical compression injury (surgery) (n = 6), L5-L6 facet exposure with no compression (sham) (n = 5), or naïve (no surgery) (n = 4) groups. The morphology of the tibiofemoral articular cartilage was assessed using a modified Mankin scoring system. Immunohistochemistry was used to examine the density of chondrocytes stained positive for SP (cells/cm2) in the ipsilateral tibiofemoral cartilage at 28 days postintervention. RESULTS Tibiofemoral cartilage in the surgery group showed consistent loss of superficial zone chondrocytes, mild roughening of the articular surface and occasional chondrocyte clusters as well as a greater density of SP mainly in the superficial cartilage zone compared with sham and naïve groups, although they also had a basic SP-expression. CONCLUSION Our results support the hypothesis that neurogenic mechanisms may mediate the spread of SP to neurosegmentally linked heterologous joints affecting the distal cartilage homeostasis. These findings contribute additional insight into the potential role of neurogenic inflammation with implications in the pathophysiology of chronic inflammatory joint disease and OA.
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Affiliation(s)
- Felipe C. K. Duarte
- Human Health and Nutritional Science, University of Guelph, Guelph, Ontario, Canada
| | - Derek P. Zwambag
- Human Health and Nutritional Science, University of Guelph, Guelph, Ontario, Canada
| | - Stephen H. M. Brown
- Human Health and Nutritional Science, University of Guelph, Guelph, Ontario, Canada
| | - Andrea Clark
- Human Health and Nutritional Science, University of Guelph, Guelph, Ontario, Canada
| | - Mark Hurtig
- Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
| | - John Z. Srbely
- Human Health and Nutritional Science, University of Guelph, Guelph, Ontario, Canada
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24
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Lima MDCL, de Araújo JIF, Gonçalves Mota C, Magalhães FEA, Campos AR, da Silva PT, Rodrigues THS, Matos MGC, de Sousa KC, de Sousa MB, Saker-Sampaio S, Pereira AL, Teixeira EH, Dos Santos HS. Antinociceptive Effect of the Essential Oil of Schinus terebinthifolius (female) Leaves on Adult Zebrafish ( Danio rerio). Zebrafish 2020; 17:112-119. [PMID: 32105571 DOI: 10.1089/zeb.2019.1809] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Schinus terebinthifolius Raddi (Anacardiaceae) is popularly known in Brazil as aroeira-da-praia and has pharmacological use as an astringent, antidiarrheal, anti-inflammatory, depurative, diuretic, and antifebrile agent. Although the neuropathic antinociceptive potential of S. terebinthifolius fruits has already been investigated, this study is the first one to analyze the acute antinociceptive effect of the essential oil of S. terebinthifolius (female) leaves (EOFSt) on adult zebrafish. EOFSt was submitted to antioxidant activity evaluation by two methods (ferrous ion-chelating capacity [FIC] and β-carotene). The animals (n = 6/group) were treated orally (20 μL) with EOFSt (0.1, 0.5, or 1.0 mg/mL) or vehicle (0.9% sodium chloride [NaCl]; 20 μL), and submitted to nociception (formalin, cinnamaldehyde, capsaicin, glutamate, acidic saline, and hypertonic saline). Possible neuromodulation mechanisms, as well motor alterations and toxicity were also evaluated. In the FIC assay, EOFSt showed ferrous ion-chelating capacity in ∼40% to 90%. Regarding the β-carotene bleaching assay, EOFSt showed inhibition in a 58% to 80% range. Oral administration of EOFSt showed no acute toxicity and did not alter the locomotor system of aZF, and reduced the nociceptive behavior in all tested models. These effects of EOFSt were significantly similar to those of morphine, used as a positive control. The antinociceptive effect of EOFSt was inhibited by naloxone, L-NAME, ketamine, camphor, ruthenium red, and amiloride. The antinociceptive effect of the EOFSt cornea was inhibited by capsazepine. EOFSt has the pharmacological potential for acute pain treatment and this effect is modulated by the opioid system, NMDA receptors, and transient receptor potential ankyrin 1 (TRPA1), transient receptor potential vanilloid 1 (TRPV1), and acid-sensing ion channels. The EOFSt also has the pharmacological potential for corneal pain treatment and this effect is modulated by the TRPV1 channel.
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Affiliation(s)
- Maria da Conceição L Lima
- Laboratory of Natural Product Bioprospecting and Biotechnology (LBPNB), Ceara State University, Department of Chemistry, Campus CECITEC, Tauá, Brazil
| | - José Ismael F de Araújo
- Laboratory of Natural Product Bioprospecting and Biotechnology (LBPNB), Ceara State University, Department of Chemistry, Campus CECITEC, Tauá, Brazil
| | - Carolina Gonçalves Mota
- Laboratory of Natural Product Bioprospecting and Biotechnology (LBPNB), Ceara State University, Department of Chemistry, Campus CECITEC, Tauá, Brazil
| | - Francisco Ernani A Magalhães
- Laboratory of Natural Product Bioprospecting and Biotechnology (LBPNB), Ceara State University, Department of Chemistry, Campus CECITEC, Tauá, Brazil
| | - Adriana R Campos
- Experimental Biology Nucleus (NUBEX), University of Fortaleza, Fortaleza, Brazil
| | - Priscila T da Silva
- Department of Biological Chemistry, Regional University of Cariri, Crato, Brazil
| | | | | | - Karolina C de Sousa
- Laboratory of Marine Natural Products, Department of Fishing Engineering, Federal University of Ceara, Fortaleza, Brazil
| | - Márcia B de Sousa
- Institute of Exact and Nature Sciences, Biological Sciences Course, University of the Integration of Afro-Brazilian Lusophony, Redenção, Ceará, Brazil
| | - Silvana Saker-Sampaio
- Laboratory of Marine Natural Products, Department of Fishing Engineering, Federal University of Ceara, Fortaleza, Brazil
| | - Anna L Pereira
- Integrated Laboratory of Biomolecules (LIBS), Federal University of Ceara, Department of Pathology and Legal Medicine, Fortaleza, Brazil
| | - Edson H Teixeira
- Integrated Laboratory of Biomolecules (LIBS), Federal University of Ceara, Department of Pathology and Legal Medicine, Fortaleza, Brazil
| | - Hélcio Silva Dos Santos
- Department of Biological Chemistry, Regional University of Cariri, Crato, Brazil.,Science and Technology Center-Chemistry Course, State University of Vale do Acarau, Sobral, Brazil
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25
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Baerlecken NT, Gaulke R, Pursche N, Witte T, Karst M, Bernateck M. Autoantibodies against P29ING4 are associated with complex regional pain syndrome. Immunol Res 2020; 67:461-468. [PMID: 32008173 DOI: 10.1007/s12026-020-09114-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Complex regional pain syndrome (CRPS) is a complication following trauma or surgery and may be difficult to diagnose since biomarkers are lacking. Using protein array technology, we found antibodies binding to p29ING4, which we further characterized using ELISA. METHODS Thirty-six sera of early-stage type 1 CRPS, 66 sera of rheumatoid arthritis (RA), 53 sera of axial spondyloarthritis (axSpA), 29 sera of psoriatic arthritis (PsA), 22 sera of patients after radial fractures (trauma control), and 100 sera of blood donors (BD) were analyzed for anti-p29ING4. We established ELISAs with 7 different antigens and using different secondary antibodies binding to IgG, IgG1, IgG2, IgG3, IgG4, IgA, and IgM, and 2 different tests to detect immune complexes (IC) of p29ING4 and IgG or IgG1. RESULTS The highest likelihood ratios versus CRPS and trauma control were observed considering the A1-23 (sensitivity 19%, specificity 100%, LR > 19) using IgG as a secondary antibody, the A120-165 (sensitivity 17%, specificity 100%, LR = 17) using IgG as a secondary antibody and the A120-165 (sensitivity 31%, specificity 95%, LR = 6.2) using IgA as a secondary antibody. IC of p29ING4 and IgG were present in 11/36 (31%) CRPS sera, 17/64 (27%) RA sera, 13/53 (25%) SpA sera, 5/29 (17%) PsA sera, 1/22 (5%) trauma control sera, and 4/100 (4%) sera of BD. IC of p29ING4 and IgG1 were present in 14/36 (39%) CRPS sera, 19/64 (30%) RA sera, 13/53 (25%) SpA, 1/29 (3%) PsA, 2/22 (9%) trauma control, and 4/100 (4%) of the BD sera. CONCLUSION Due to the lack of other biomarkers of type 1 CRPS, P29ING4 autoantibodies could be helpful in its diagnostic work-up.
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Affiliation(s)
| | - R Gaulke
- Trauma Department, Medical University Hannover, Hannover, Germany
| | - N Pursche
- Department of Clinical Immunology and Rheumatology, Medical University Hannover, Hannover, Germany
| | - T Witte
- Department of Clinical Immunology and Rheumatology, Medical University Hannover, Hannover, Germany
| | - M Karst
- Department of Anesthesiology, Pain Clinic, Medical University Hannover, Hannover, Germany
| | - M Bernateck
- Department of Anesthesiology, Pain Clinic, Medical University Hannover, Hannover, Germany
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26
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Eldufani J, Elahmer N, Blaise G. A medical mystery of complex regional pain syndrome. Heliyon 2020; 6:e03329. [PMID: 32149194 PMCID: PMC7033333 DOI: 10.1016/j.heliyon.2020.e03329] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 12/31/2019] [Accepted: 01/27/2020] [Indexed: 12/12/2022] Open
Abstract
Complex regional pain syndrome (CRPS) is a condition of neuropathic pain, which is characterized by significant autonomic and inflammatory features. CRPS occurs in patients who have limb surgery, limb fractures, or trauma. Many patients may have pain resolve within twelve months of the inciting incident; however, a small subset progresses to the chronic form. This transitional process often happens by changing from warm CRPS with dominant inflammatory phase to cold CRPS, in which autonomic characteristics or manifestations dominate. Several peripheral and central mechanisms are involved, which might vary among individuals over a period of time. Other contributors include peripheral and central sensitization, autonomic alterations, inflammatory and immune changes, neurochemical changes, and psychological and genetic factors. Although effective management of the chronic CRPS form is often challenging, there are a few high quality randomized controlled trials that support the efficacy of the most commonly used therapeutic approaches.
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Affiliation(s)
- Jabril Eldufani
- Department of Medicine, Faculty of Medicine, Elmergib University, El-khums, Libya
- Department of Medicine and Anesthesia, Faculty of Medicine, University of Montréal, Montreal, Quebec, Canada
| | - Nyruz Elahmer
- Department of Pharmacology and Physiology, Faculty of Medicine, University of Montréal, Montreal, Quebec, Canada
| | - Gilbert Blaise
- Department of Medicine and Anesthesia, Faculty of Medicine, University of Montréal, Montreal, Quebec, Canada
- Department of Anesthesiology and Pain Management, Centre hospitalier de l’Université de Montréal (CHUM), Montreal, Quebec, Canada
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27
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Royds J, Conroy MJ, Dunne MR, McCrory C, Lysaght J. An investigation into the modulation of T cell phenotypes by amitriptyline and nortriptyline. Eur Neuropsychopharmacol 2020; 31:131-144. [PMID: 31882254 DOI: 10.1016/j.euroneuro.2019.12.106] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 11/21/2019] [Accepted: 12/08/2019] [Indexed: 02/06/2023]
Abstract
Amitriptyline is prescribed for treating the symptoms of neuroinflammatory disorders including neuropathic pain and fibromyalgia. As amitriptyline has evidence of modulating the neuroimmune interface; the effects of amitriptyline treatment on T-cell phenotype and function were examined in vitro. Peripheral blood mononuclear cells(PBMCs) were isolated and treated with amitriptyline, nortriptyline and a combination of both drugs. Toxicity for T-cells was assessed by Annexin V/Propidium Iodide staining. Activation status and cytokine expression by T-cells post treatment was assessed by flow cytometry. The levels of secreted cytokines, chemokines and neurotrophins were measured by ELISA in the supernatants. There was no significant increase in T-cell death following 24 or 48 h compared to controls. There were significantly lower frequencies of CD8+ T-cells after treatment with amitriptyline, nortriptyline and a combination of both compared to a Vehicle Control(VC)(p<0.001). The frequencies of naive CD8+CD45RA+ cells were significantly lower after amitriptyline, nortriptyline and a combination of both (p<0001). The frequencies of CD27+CD4+(p<0.05) and CD27+CD8+(p<0.01) T-cells were also significantly lower following combination drug treatment. Significantly lower frequencies of IFN-γ-producing CD8+ T-cells were observed with all treatment combinations(p<0.05) and frequencies of IL-17-producing CD4+ and CD8+ T-cells were significantly lower following amitriptyline treatment (p<0.05). Frequencies of Natural Killer T-cells were significantly higher following treatment with nortriptyline (p<0.05). Significantly higher levels of IL-16 (p<0.001) and lower levels of TNF-β (p<0.05) were observed in supernatants. This data indicates that both amitriptyline and nortriptyline modulate the phenotype and function of T-cells and this may have clinical relevance in the pathologies of its off-label applications.
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Affiliation(s)
- Jonathan Royds
- Department of Pain Medicine, St James's Hospital, Dublin 8, Ireland.
| | - Melissa J Conroy
- Department of Surgery, Trinity Translational Medicine Institute, St. James's Hospital and Trinity College Dublin, Dublin 8, Ireland
| | - Margaret R Dunne
- Department of Surgery, Trinity Translational Medicine Institute, St. James's Hospital and Trinity College Dublin, Dublin 8, Ireland
| | - Connail McCrory
- Department of Pain Medicine, St James's Hospital, Dublin 8, Ireland
| | - Joanne Lysaght
- Department of Surgery, Trinity Translational Medicine Institute, St. James's Hospital and Trinity College Dublin, Dublin 8, Ireland
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28
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Varrassi G, Alon E, Bagnasco M, Lanata L, Mayoral-Rojals V, Paladini A, Pergolizzi JV, Perrot S, Scarpignato C, Tölle T. Towards an Effective and Safe Treatment of Inflammatory Pain: A Delphi-Guided Expert Consensus. Adv Ther 2019; 36:2618-2637. [PMID: 31485978 PMCID: PMC6822819 DOI: 10.1007/s12325-019-01053-x] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Indexed: 12/17/2022]
Abstract
OBJECTIVE The clinical management of inflammatory pain requires an optimal balance between effective analgesia and associated safety risks. To date, mechanisms associated with inflammatory pain are not completely understood because of their complex nature and the involvement of both peripheral and central mechanisms. This Expert Consensus document is intended to update clinicians about evolving areas of clinical practice and/or available treatment options for the management of patients with inflammatory pain. METHOD An international group of experts in pain management covering the pharmacology, neurology and rheumatology fields carried out an independent qualitative systematic literature search using MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials. RESULTS Existing guidelines for pain management provide recommendations that do not satisfactorily address the complex nature of pain. To achieve optimal outcomes, drug choices should be individualized to guarantee the best match between the characteristics of the patient and the properties of the medication. NSAIDs represent an important prescribing choice in the management of inflammatory pain, and the recent results on paracetamol question its appropriate use in clinical practice, raising the need for re-evaluation of the recommendations in the clinical practice guidelines. CONCLUSIONS Increasing clinicians' knowledge of the available pharmacologic options to treat different pain mechanisms offers the potential for safe, individualized treatment decisions. We hope that it will help implement the needed changes in the management of inflammatory pain by providing the best strategies and new insights to achieve the ultimate goal of managing the disease and obtaining optimal benefits for patients. FUNDING Dompé Farmaceutici SPA and Paolo Procacci Foundation.
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Affiliation(s)
- Giustino Varrassi
- Paolo Procacci Foundation, Rome, Italy.
- President of World Institute of Pain (WIP), Winston-Salem, NC, USA.
| | - Eli Alon
- University of Zurich, Zurich, Switzerland
| | - Michela Bagnasco
- Medical Affairs Department, Dompé Farmaceutici SpA, Milan, Italy
| | - Luigi Lanata
- Medical Affairs Department, Dompé Farmaceutici SpA, Milan, Italy
| | | | | | | | - Serge Perrot
- Descartes University and Cochin-Hotel Dieu Hospital, Paris, France
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29
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Abstract
Abstract
Editor’s Perspective
What We Already Know about This Topic
What This Article Tells Us That Is New
Background
Sympathetic dysfunction may be present in complex regional pain syndrome, and sympathetic blocks are routinely performed in practice. To investigate the therapeutic and predictive values of sympathetic blocks, the authors test the hypotheses that sympathetic blocks provide analgesic effects that may be associated with the temperature differences between the two extremities before and after the blocks and that the effects of sympathetic blocks may predict the success (defined as achieving more than 50% pain reduction) of spinal cord stimulation trials.
Methods
The authors performed a retrospective study of 318 patients who underwent sympathetic blocks in a major academic center (2009 to 2016) to assess the association between pain reduction and preprocedure temperature difference between the involved and contralateral limbs. The primary outcome was pain improvement by more than 50%, and the secondary outcome was duration of more than 50% pain reduction per patient report. The authors assessed the association between pain reduction and the success rate of spinal cord stimulation trials.
Results
Among the 318 patients, 255 were diagnosed with complex regional pain syndrome and others with various sympathetically related disorders. Successful pain reduction (more than 50%) was observed in 155 patients with complex regional pain syndrome (155 of 255, 61%). The majority of patients (132 of 155, 85%) experienced more than 50% pain relief for 1 to 4 weeks or longer. The degree and duration of pain relief were not associated with preprocedure temperature parameters with estimated odds ratio of 1.03 (97.5% CI, 0.95–1.11) or 1.01 (97.5% CI, 0.96–1.06) for one degree decrease (P = 0.459 or 0.809). There was no difference in the success rate of spinal cord stimulation trials between patients with or without more than 50% pain relief after sympathetic blocks (35 of 40, 88% vs. 26 of 29, 90%, P > 0.990).
Conclusions
The authors conclude that sympathetic blocks may be therapeutic in patients with complex regional pain syndrome regardless of preprocedure limb temperatures. The effects of sympathetic blocks do not predict the success of spinal cord stimulation.
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30
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Does diet play a role in reducing nociception related to inflammation and chronic pain? Nutrition 2019; 66:153-165. [DOI: 10.1016/j.nut.2019.04.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 03/22/2019] [Accepted: 04/01/2019] [Indexed: 02/07/2023]
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31
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Rasmussen VF, Karlsson P, Drummond PD, Schaldemose EL, Terkelsen AJ, Jensen TS, Knudsen LF. Bilaterally Reduced Intraepidermal Nerve Fiber Density in Unilateral CRPS-I. PAIN MEDICINE 2019; 19:2021-2030. [PMID: 30299507 DOI: 10.1093/pm/pnx240] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Objective Findings regarding small nerve fiber damage in complex regional pain syndrome type I (CRPS-I) are not uniform, and studies have not included a matched healthy control group. The aim was to assess intraepidermal nerve fiber density (IENFD) in relation to thermal sensitivity of the same skin areas in CRPS-I patients and a gender- and age-matched healthy control group. Methods IENFD was investigated in skin biopsies from the CRPS-affected and contralateral limbs of eight CRPS-I patients and from an equivalent site in eight gender- and age-matched healthy controls (HCs). Thermal thresholds (cold/warm detection, cold- and heat-pain detection) were assessed on the affected limb, the matching contralateral limb, and on the equivalent limbs of HCs, and participants rated the intensity of cold/heat and pain to static thermal stimuli (5 °C and 40 °C). Results IENFD was significantly lower in both the affected and contralateral limbs of CRPS-I patients than HCs, but IENFD did not differ between the affected and contralateral limbs of patients. The heat pain threshold was lower in the affected CRPS-I limb than in HCs, but all other thermal thresholds were similar in both groups. CRPS-I patients rated the cold stimulus as colder and more painful in the affected limb, and the warm stimulus as hotter, bilaterally, than the HCs. Conclusions CRPS-I may be associated with bilateral small fiber damage, and perhaps small fiber neuropathy and bilateral disturbances in thermo-sensory perception. These disturbances could stem from a systemic response to injury or might increase the risk of developing CRPS-I after physical trauma.
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Affiliation(s)
- Vinni F Rasmussen
- Danish Pain Research Center, Aarhus University Hospital, Aarhus, Denmark
| | - Páll Karlsson
- Danish Pain Research Center, Aarhus University Hospital, Aarhus, Denmark.,Stereology and Electron Microscopy Laboratory, Centre for Stochastic Geometry and Advanced Bioimaging, Aarhus University Hospital, Aarhus, Denmark
| | - Peter D Drummond
- School of Psychology and Exercise Science, Centre for Research on Chronic Pain and Inflammatory Diseases, Murdoch University, Perth, Western Australia
| | | | - Astrid J Terkelsen
- Danish Pain Research Center, Aarhus University Hospital, Aarhus, Denmark
| | - Troels S Jensen
- Danish Pain Research Center, Aarhus University Hospital, Aarhus, Denmark
| | - Lone F Knudsen
- Danish Pain Research Center, Aarhus University Hospital, Aarhus, Denmark.,Spinal Cord Injury Centre of Western Denmark, Viborg Regional Hospital, Viborg, Denmark
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32
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Salgado ASI, Stramosk J, Ludtke DD, Kuci ACC, Salm DC, Ceci LA, Petronilho F, Florentino D, Danielski LG, Gassenferth A, Souza LR, Rezin GT, Santos ARS, Mazzardo-Martins L, Reed WR, Martins DF. Manual Therapy Reduces Pain Behavior and Oxidative Stress in a Murine Model of Complex Regional Pain Syndrome Type I. Brain Sci 2019; 9:brainsci9080197. [PMID: 31405150 PMCID: PMC6721404 DOI: 10.3390/brainsci9080197] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 08/08/2019] [Accepted: 08/08/2019] [Indexed: 01/24/2023] Open
Abstract
Complex regional pain syndrome type I (CRPS-I) is a chronic painful condition. We investigated whether manual therapy (MT), in a chronic post-ischemia pain (CPIP) model, is capable of reducing pain behavior and oxidative stress. Male Swiss mice were subjected to ischemia-reperfusion (IR) to mimic CRPS-I. Animals received ankle joint mobilization 48h after the IR procedure, and response to mechanical stimuli was evaluated. For biochemical analyses, mitochondrial function as well as oxidative stress thiobarbituric acid reactive substances (TBARS), protein carbonyls, antioxidant enzymes superoxide dismutase (SOD) and catalase (CAT) levels were determined. IR induced mechanical hyperalgesia which was subsequently reduced by acute MT treatment. The concentrations of oxidative stress parameters were increased following IR with MT treatment preventing these increases in malondialdehyde (MDA) and carbonyls protein. IR diminished the levels of SOD and CAT activity and MT treatment prevented this decrease in CAT but not in SOD activity. IR also diminished mitochondrial complex activity, and MT treatment was ineffective in preventing this decrease. In conclusion, repeated sessions of MT resulted in antihyperalgesic effects mediated, at least partially, through the prevention of an increase of MDA and protein carbonyls levels and an improvement in the antioxidant defense system.
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Affiliation(s)
- Afonso S I Salgado
- Coordinator of Integrative Physical Therapy Residency-Philadelphia University Center, Londrina 86020-000, Paraná, Brazil
- Experimental Neuroscience Laboratory (LaNEx), University of Southern Santa Catarina, Palhoça 88137-270, Santa Catarina, Brazil
| | - Juliana Stramosk
- Experimental Neuroscience Laboratory (LaNEx), University of Southern Santa Catarina, Palhoça 88137-270, Santa Catarina, Brazil
| | - Daniela D Ludtke
- Experimental Neuroscience Laboratory (LaNEx), University of Southern Santa Catarina, Palhoça 88137-270, Santa Catarina, Brazil
- Postgraduate Program in Health Sciences, University of Southern Santa Catarina, Palhoça 88137-270, Santa Catarina, Brazil
| | - Ana C C Kuci
- Experimental Neuroscience Laboratory (LaNEx), University of Southern Santa Catarina, Palhoça 88137-270, Santa Catarina, Brazil
| | - Daiana C Salm
- Experimental Neuroscience Laboratory (LaNEx), University of Southern Santa Catarina, Palhoça 88137-270, Santa Catarina, Brazil
- Postgraduate Program in Health Sciences, University of Southern Santa Catarina, Palhoça 88137-270, Santa Catarina, Brazil
| | - Lisandro A Ceci
- Experimental Neuroscience Laboratory (LaNEx), University of Southern Santa Catarina, Palhoça 88137-270, Santa Catarina, Brazil
- Postgraduate Program in Health Sciences, University of Southern Santa Catarina, Palhoça 88137-270, Santa Catarina, Brazil
| | - Fabricia Petronilho
- Laboratory of Neurobiology of Inflammatory and Metabolic Processes, Graduate Program in Health Sciences, Health Sciences Unit, University of South Santa Catarina, Tubarão 88704-900, Santa Catarina, Brazil
| | - Drielly Florentino
- Laboratory of Neurobiology of Inflammatory and Metabolic Processes, Graduate Program in Health Sciences, Health Sciences Unit, University of South Santa Catarina, Tubarão 88704-900, Santa Catarina, Brazil
| | - Lucineia G Danielski
- Laboratory of Neurobiology of Inflammatory and Metabolic Processes, Graduate Program in Health Sciences, Health Sciences Unit, University of South Santa Catarina, Tubarão 88704-900, Santa Catarina, Brazil
| | - Aline Gassenferth
- Laboratory of Neurobiology of Pain and Inflammation, Department of Physiological Sciences, Centre of Biological Sciences, University Federal of Santa Catarina, Florianópolis 88040-900, Santa Catarina, Brazil
| | - Luana R Souza
- Postgraduate Program in Neuroscience, Center of Biological Sciences, Federal University of Santa Catarina, Florianópolis 88040-900, Santa Catarina, Brazil
| | - Gislaine T Rezin
- Department of Physical Therapy, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL 35294-1212, USA
| | - Adair R S Santos
- Laboratory of Neurobiology of Pain and Inflammation, Department of Physiological Sciences, Centre of Biological Sciences, University Federal of Santa Catarina, Florianópolis 88040-900, Santa Catarina, Brazil
- Postgraduate Program in Neuroscience, Center of Biological Sciences, Federal University of Santa Catarina, Florianópolis 88040-900, Santa Catarina, Brazil
| | - Leidiane Mazzardo-Martins
- Postgraduate Program in Neuroscience, Center of Biological Sciences, Federal University of Santa Catarina, Florianópolis 88040-900, Santa Catarina, Brazil
| | - William R Reed
- Department of Physical Therapy, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL 35294-1212, USA
| | - Daniel F Martins
- Coordinator of Integrative Physical Therapy Residency-Philadelphia University Center, Londrina 86020-000, Paraná, Brazil.
- Experimental Neuroscience Laboratory (LaNEx), University of Southern Santa Catarina, Palhoça 88137-270, Santa Catarina, Brazil.
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33
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Ilie MA, Caruntu C, Tampa M, Georgescu SR, Matei C, Negrei C, Ion RM, Constantin C, Neagu M, Boda D. Capsaicin: Physicochemical properties, cutaneous reactions and potential applications in painful and inflammatory conditions. Exp Ther Med 2019; 18:916-925. [PMID: 31384324 PMCID: PMC6639979 DOI: 10.3892/etm.2019.7513] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 09/21/2018] [Indexed: 12/14/2022] Open
Abstract
Capsaicin is a natural protoalkaloid recognized as the main pungent component in hot peppers (Capsicum annuum L.). The capsaicin receptor is highly expressed in the unmyelinated type C nerve fibers originating from small diameter sensory neurons in dorsal root ganglia and cranial nerve ganglia correspondents. Capsaicin and related vanilloids have a variety of effects on primary sensory neurons function, from sensory neuron excitation characterized by local burning sensation and neurogenic inflammation, followed by conduction blockage accompanied by reversible ultrastructural changes of peripheral nociceptive endings (desensitization), going as far as irreversible degenerative changes (neurotoxicity). The main role in capsaicin-induced neurogenic inflammation relies on the capsaicin sensitive, small diameter primary sensory neurons, therefore its evaluation could be used as a diagnostic instrument in functional alterations of cutaneous sensory nerve fibers. Moreover, capsaicin-induced desensitization and neurotoxicity explain the analgesic/anti-nociceptive and anti-inflammatory effects of topical capsaicin and its potential use in the management of painful and inflammatory conditions. In this study, we describe the effects of capsaicin on neurogenic inflammation and nociception, as well as its potential diagnostic value and therapeutic impact in various conditions involving impairment of sensory nerve fibers.
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Affiliation(s)
- Mihaela Adriana Ilie
- Dermatology Research Laboratory, ‘Carol Davila’ University of Medicine and Pharmacy, Bucharest 020021, Romania
- Department of Biochemistry, ‘Carol Davila’ University of Medicine and Pharmacy, Bucharest 020021, Romania
| | - Constantin Caruntu
- Department of Physiology, ‘Carol Davila’ University of Medicine and Pharmacy, Bucharest 020021, Romania
- Department of Dermatology, ‘Prof. N.C. Paulescu’ National Institute of Diabetes, Nutrition and Metabolic Diseases, Bucharest 020475, Romania
| | - Mircea Tampa
- Department of Dermatology, ‘Carol Davila’ University of Medicine and Pharmacy, Bucharest 020021, Romania
| | - Simona-Roxana Georgescu
- Department of Dermatology, ‘Carol Davila’ University of Medicine and Pharmacy, Bucharest 020021, Romania
| | - Clara Matei
- Department of Dermatology, ‘Carol Davila’ University of Medicine and Pharmacy, Bucharest 020021, Romania
| | - Carolina Negrei
- Department of Toxicology, Faculty of Pharmacy, ‘Carol Davila’ University of Medicine and Pharmacy, Bucharest 020956, Romania
| | - Rodica-Mariana Ion
- The National Institute for Research and Development in Chemistry and Petrochemistry - ICECHIM, Bucharest 060021, Romania
| | - Carolina Constantin
- Department of Immunology, ‘Victor Babes’ National Institute of Pathology, Bucharest 050096, Romania
- Department of Pathology, Colentina Clinical Hospital, 020125 Bucharest, Romania
| | - Monica Neagu
- Department of Immunology, ‘Victor Babes’ National Institute of Pathology, Bucharest 050096, Romania
- Department of Pathology, Colentina Clinical Hospital, 020125 Bucharest, Romania
- Department of Biochemistry, Faculty of Biology, University of Bucharest, Bucharest 020125, Romania
| | - Daniel Boda
- Dermatology Research Laboratory, ‘Carol Davila’ University of Medicine and Pharmacy, Bucharest 020021, Romania
- Department of Dermatology, ‘Prof. N.C. Paulescu’ National Institute of Diabetes, Nutrition and Metabolic Diseases, Bucharest 020475, Romania
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Bjørklund G, Chirumbolo S, Dadar M, Pen JJ, Doşa MD, Pivina L, Semenova Y, Aaseth J. Insights on Nutrients as Analgesics in Chronic Pain. Curr Med Chem 2019; 27:6407-6423. [PMID: 31309880 DOI: 10.2174/0929867326666190712172015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 06/26/2019] [Accepted: 07/01/2019] [Indexed: 02/07/2023]
Abstract
Many serious inflammatory disorders and nutrient deficiencies induce chronic pain, and anti-inflammatory diets have been applied successfully to modify the inflammatory symptoms causing chronic pain. Numerous scientific data and clinical investigations have demonstrated that long-term inflammation could lead to an inappropriate or exaggerated sensibility to pain. In addition, some Non-steroidal Anti-inflammatory Drugs (NSAID), which directly act on the many enzymes involved in pain and inflammation, including cyclooxygenases, are used to dampen the algesic signal to the central nervous system, reducing the responses of soft C-fibers to pain stimuli. On the other hand, there are a few reports from both health authorities and physicians, reporting that decreased transmission of pain signals can be achieved and improved, depending on the patient's dietary habit. Many nutrients, as well as a suitable level of exercise (resistance training), are the best methods for improving the total mitochondrial capacity in muscle cells, which can lead to a reduction in sensitivity to pain, particularly by lowering the inflammatory signaling to C-fibers. According to the current literature, it could be proposed that chronic pain results from the changed ratio of neuropeptides, hormones, and poor nutritional status, often related to an underlying inflammatory disorder. The current review also evaluates the effective role of nutrition-related interventions on the severity of chronic pain. This review pointed out that nutritional interventions can have a positive effect on pain experience through the indirect inhibitory effect on prostaglandin E2 and attenuation of mitochondrial dysfunction caused by ischemia/reperfusion in skeletal muscle, improving the intracellular antioxidant defense system. These data highlight the need for more nutrition studies where chronic pain is the primary outcome, using accurate interventions. To date, no nutritional recommendation for chronic pain has been officially proposed. Therefore, the goal of this article is to explore pain management and pain modulation, searching for a mode of nutrition efficient in reducing pain.
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Affiliation(s)
- Geir Bjørklund
- Council for Nutritional and Environmental Medicine (CONEM), Mo i Rana, Norway
| | - Salvatore Chirumbolo
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy,CONEM Scientific Secretary, Verona, Italy
| | - Maryam Dadar
- Razi Vaccine and Serum Research Institute, Agricultural Research, Education and Extension Organization (AREEO), Karaj, Iran
| | - Joeri J Pen
- Diabetes Clinic, Department of Internal Medicine, UZ Brussel, Vrije Universiteit Brussel (VUB), Brussels, Belgium,Department of Nutrition, UZ Brussel, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Monica Daniela Doşa
- Department of Pharmacology, Faculty of Medicine, Ovidius University, Constanta, Romania
| | - Lyudmila Pivina
- Semey Medical University, Semey, Kazakhstan,CONEM Kazakhstan Environmental Health and Safety Research Group, Semey Medical University, Semey, Kazakhstan
| | - Yulia Semenova
- Semey Medical University, Semey, Kazakhstan,CONEM Kazakhstan Environmental Health and Safety Research Group, Semey Medical University, Semey, Kazakhstan
| | - Jan Aaseth
- Research Department, Innlandet Hospital Trust, Brumunddal, Norway,Faculty of Health and Social Science, Inland Norway University of Applied Sciences, Elverum, Norway
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Graillon N, Le Roux MK, Chossegros C, Haen P, Lutz JC, Foletti JM. Botulinum toxin for ductal stenosis and fistulas of the main salivary glands. Int J Oral Maxillofac Surg 2019; 48:1411-1414. [PMID: 31072799 DOI: 10.1016/j.ijom.2019.04.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 03/07/2019] [Accepted: 04/25/2019] [Indexed: 11/24/2022]
Abstract
This study was performed to present the authors' experience with botulinum toxin therapy for salivary stenosis and salivary fistula in terms of the procedure, dosage, effectiveness, and complications. A retrospective study of all patients treated in the maxillofacial surgery department for salivary stenosis or fistula from January 2014 to September 2018 was performed. Intraglandular injections of incobotulinumtoxinA (Xeomin) were utilized. The frequency of relapse and the pain recorded before injection and at 3 months after each injection or fistula resolution were assessed. Swallowing dysfunction or any diffusion of toxin into the facial muscles was recorded. This study included 22 patients (mean age 53 years). Botulinum therapy was indicated for parotid duct stenosis in 14 patients, submandibular duct stenosis in four patients, and parotid fistula in four patients. The frequency of relapse (P = 0.0001) and pain level (P = 0.0001) decreased after botulinum therapy. The average duration of the botulinum effect was 4.50±2.00 months after the first injection. No complication was observed. Botulinum therapy with 100 IU of Xeomin proved effective at resolving salivary fistula. Botulinum therapy is an effective treatment for symptoms of salivary duct stenosis in patients for whom minimally invasive procedures have failed. Botulinum therapy can also be used for the treatment of salivary fistulas.
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Affiliation(s)
- N Graillon
- Department of Oral and Maxillofacial Surgery, Aix Marseille Université, APHM, IFSTTAR, LBA, CHU Conception, Marseille, France.
| | - M K Le Roux
- Department of Oral and Maxillofacial Surgery, Aix Marseille Université, APHM, IFSTTAR, LBA, CHU Conception, Marseille, France
| | - C Chossegros
- Department of Oral and Maxillofacial Surgery, Aix Marseille Université, APHM, CHU Conception, Marseille, France
| | - P Haen
- Department of Oral and Maxillofacial Surgery, Hôpital Laveran, boulevard Laveran, Marseille, France
| | - J C Lutz
- Oral and Maxillofacial Surgery Department, Strasbourg University Hospital, Strasbourg, France
| | - J M Foletti
- Department of Oral and Maxillofacial Surgery, Aix Marseille Université, APHM, IFSTTAR, LBA, CHU Conception, Marseille, France
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Popkirov S, Hoeritzauer I, Colvin L, Carson AJ, Stone J. Complex regional pain syndrome and functional neurological disorders - time for reconciliation. J Neurol Neurosurg Psychiatry 2019; 90:608-614. [PMID: 30355604 DOI: 10.1136/jnnp-2018-318298] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 09/27/2018] [Accepted: 09/28/2018] [Indexed: 12/17/2022]
Abstract
There have been many articles highlighting differences and similarities between complex regional pain syndrome (CRPS) and functional neurological disorders (FND) but until now the discussions have often been adversarial with an erroneous focus on malingering and a view of FND as 'all in the mind'. However, understanding of the nature, frequency and treatment of FND has changed dramatically in the last 10-15 years. FND is no longer assumed to be only the result of 'conversion' of psychological conflict but is understood as a complex interplay between physiological stimulus, expectation, learning and attention mediated through a Bayesian framework, with biopsychosocial predisposing, triggering and perpetuating inputs. Building on this new 'whole brain' perspective of FND, we reframe the debate about the 'psychological versus physical' basis of CRPS. We recognise how CRPS research may inform mechanistic understanding of FND and conversely, how advances in FND, especially treatment, have implications for improving understanding and management of CRPS.
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Affiliation(s)
- Stoyan Popkirov
- Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Ruhr University Bochum, Bochum, Germany
| | - Ingrid Hoeritzauer
- Centre for Clinical Brain Sciences, Western General Hospital, NHS Lothian and University of Edinburgh, Edinburgh, UK
| | - Lesley Colvin
- Division of Population Health Sciences and Genomics, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
| | - Alan J Carson
- Centre for Clinical Brain Sciences, Western General Hospital, NHS Lothian and University of Edinburgh, Edinburgh, UK
| | - Jon Stone
- Centre for Clinical Brain Sciences, Western General Hospital, NHS Lothian and University of Edinburgh, Edinburgh, UK
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Singh S, Kartha S, Bulka BA, Stiansen NS, Winkelstein BA. Physiologic facet capsule stretch can induce pain & upregulate matrix metalloproteinase-3 in the dorsal root ganglia when preceded by a physiological mechanical or nonpainful chemical exposure. Clin Biomech (Bristol, Avon) 2019; 64:122-130. [PMID: 29523370 PMCID: PMC6067996 DOI: 10.1016/j.clinbiomech.2018.01.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 12/22/2017] [Accepted: 01/15/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Neck pain from cervical facet loading is common and induces inflammation and upregulation of nerve growth factor (NGF) that can sensitize the joint afferents. Yet, the mechanisms by which these occur and whether afferents can be pre-conditioned by certain nonpainful stimuli are unknown. This study tested the hypothesis that a nonpainful mechanical or chemical insult predisposes a facet joint to generate pain after a later exposure to typically nonpainful distraction. METHODS Rats were exposed to either a nonpainful distraction or an intra-articular subthreshold dose of NGF followed by a nonpainful distraction two days later. Mechanical hyperalgesia was measured daily and C6 dorsal root ganglia (DRG) tissue was assayed for NGF and matrix metalloproteinase-3 (MMP-3) expression on day 7. FINDINGS The second distraction increased joint displacement and strains compared to its first application (p = 0.0011). None of the initial exposures altered behavioral sensitivity in either of the groups being pre-conditioned or in controls; but, sensitivity was established in both groups receiving a second distraction within one day that lasted until day 7 (p < 0.024). NGF expression in the DRG was increased in both groups undergoing a pre-conditioning exposure (p < 0.0232). Similar findings were observed for MMP-3 expression, with a pre-conditioning exposure increasing levels after an otherwise nonpainful facet distraction. INTERPRETATION These findings suggest that nonpainful insults to the facet joint, when combined, can generate painful outcomes, possibly mediated by upregulation of MMP-3 and mature NGF.
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Affiliation(s)
- Sagar Singh
- Department of Bioengineering, University of Pennsylvania, 210 S. 33rd Street, 240 Skirkanich Hall, Philadelphia, PA 19104, USA
| | - Sonia Kartha
- Department of Bioengineering, University of Pennsylvania, 210 S. 33rd Street, 240 Skirkanich Hall, Philadelphia, PA 19104, USA
| | - Ben A Bulka
- Department of Bioengineering, University of Pennsylvania, 210 S. 33rd Street, 240 Skirkanich Hall, Philadelphia, PA 19104, USA
| | - Nicholas S Stiansen
- Department of Bioengineering, University of Pennsylvania, 210 S. 33rd Street, 240 Skirkanich Hall, Philadelphia, PA 19104, USA
| | - Beth A Winkelstein
- Department of Bioengineering, University of Pennsylvania, 210 S. 33rd Street, 240 Skirkanich Hall, Philadelphia, PA 19104, USA; Department of Neurosurgery, University of Pennsylvania, 210 S. 33rd Street, 240 Skirkanich Hall, Philadelphia, PA 19104, USA.
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Abstract
The common chronic pain syndromes of fibromyalgia, regional pain syndrome, and complex regional pain syndrome have been made to appear separate because they have been historically described by different groups and with different criteria, but they are really phenotypically accented expressions of the same processes triggered by emotional distress and filtered or modified by genetics, psychology, and local physical factors.
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Affiliation(s)
- Geoffrey Owen Littlejohn
- Department of Medicine, Monash University, Clayton, Victoria, 3168, Australia.,Department of Rheumatology, Monash Health, Monash Medical Centre, Clayton, Victoria, 3168, Australia
| | - Emma Guymer
- Department of Medicine, Monash University, Clayton, Victoria, 3168, Australia.,Department of Rheumatology, Monash Health, Monash Medical Centre, Clayton, Victoria, 3168, Australia
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Compared to limb pain of other origin, ultrasonographic osteodensitometry reveals loss of bone density in complex regional pain syndrome. Pain 2019; 160:1261-1269. [DOI: 10.1097/j.pain.0000000000001520] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Duarte FCK, Hurtig M, Clark A, Simpson J, Srbely JZ. Association between naturally occurring spine osteoarthritis in geriatric rats and neurogenic inflammation within neurosegmentally linked skeletal muscle. Exp Gerontol 2019; 118:31-38. [PMID: 30615897 DOI: 10.1016/j.exger.2019.01.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 12/12/2018] [Accepted: 01/02/2019] [Indexed: 12/15/2022]
Abstract
OBJECTIVE This study aimed to investigate the association between naturally occurring spinal osteoarthritis (OA) (L3-L5), the expression of substance P (SP) centrally (L4-L5) and the presence of neurogenic inflammation within the neurosegmentally linked quadriceps (L2-L5) in elderly rats versus young controls. DESIGN Eight aged (27 ± 3.2 months) and six young (4 ± 0.0 months) male Wistar Kyoto rats were euthanized and submitted to micro-computerized tomography for determination of spine OA. SP expression (% area) at the dorsal horn of the spinal cord as well as the relative expression of SP and protease-activated receptor 2 (PAR2) to alpha-tubulin within quadriceps muscle were determined by immunohistochemistry and Western Blot. RESULTS Spine osteoarthritis was confirmed in all aged rats but no young controls. Aged rats expressed significant increase of SP protein expression within the dorsal horn (MD = 0.086; 95% CI [0.026 to 0.145]; p = 0.0094) and quadriceps (MD = 1.209; 95% CI [0.239 to 2.179]; p = 0.0191) and PAR2 (MD = 0.797; 95% CI [0.160 to 1.435]; p = 0.0187) compared to young controls. CONCLUSION These observations provide novel insight into the potential role of neurogenic inflammation in the pathophysiology of myofascial pain syndrome in the naturally occurring spinal OA in elderly population.
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Affiliation(s)
- Felipe C K Duarte
- Department of Human Health and Nutritional Science, University of Guelph, 50 Stone Road East, Guelph, ON N1G 2W1, Canada.
| | - Mark Hurtig
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, 50 McGilvray Lane, Guelph, ON N1G 2W1, Canada.
| | - Andrea Clark
- Department of Human Health and Nutritional Science, University of Guelph, 50 Stone Road East, Guelph, ON N1G 2W1, Canada.
| | - Jeremy Simpson
- Department of Human Health and Nutritional Science, University of Guelph, 50 Stone Road East, Guelph, ON N1G 2W1, Canada.
| | - John Z Srbely
- Department of Human Health and Nutritional Science, University of Guelph, 50 Stone Road East, Guelph, ON N1G 2W1, Canada.
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Fan Y, Kim DH, Ryu Y, Chang S, Lee BH, Yang CH, Kim HY. Neuropeptides SP and CGRP Underlie the Electrical Properties of Acupoints. Front Neurosci 2018; 12:907. [PMID: 30618546 PMCID: PMC6299809 DOI: 10.3389/fnins.2018.00907] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 11/19/2018] [Indexed: 12/16/2022] Open
Abstract
Electrical skin measurements at acupuncture points (acupoints) have been utilized as a diagnostic and therapeutic aid for more than 50 years. Although acupoints are described as having distinct electrical properties, such as high conductance and low impedance, the underlying mechanisms are currently unknown. The present study investigated in a rat model of hypertension whether the high conductance at acupoints is a result of the release of the neuropeptides substance P (SP) and calcitonin gene-related peptide (CGRP) during neurogenic inflammation in the referred pain area. When plasma extravasation from neurogenic inflammation was examined by exploring the leakage of intravenously injected Evans blue dye (EBD) to the skin, extravasated EBD was found most frequently in acupoints on the wrist. The increased conductance and temperature at these acupoints occurred during the development of hypertension. The increase in conductance and plasma extravasation at acupoints in hypertensive rats was ablated by cutting median and ulnar nerves, blocking small diameter afferent fibers with resiniferatoxin (RTX) injection into median and ulnar nerves, or antagonizing SP or CGRP receptors in acupoints. In turn, intradermal injection of SP or CGRP resulted in increased conductance and plasma extravasation in naïve rats. Elevated levels of SP and CGRP were found in the acupoints of hypertensive rats. These findings suggest that the high conductance at acupoints is due to vascular leakage following local release of SP and CGRP during neurogenic inflammation.
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Affiliation(s)
- Yu Fan
- Department of Physiology, College of Korean Medicine, Daegu Haany University, Daegu, South Korea
| | - Do-Hee Kim
- Department of Physiology, College of Korean Medicine, Daegu Haany University, Daegu, South Korea
| | - Yeonhee Ryu
- Korean Medicine Fundamental Research Division, Korea Institute of Oriental Medicine, Daejeon, South Korea
| | - Suchan Chang
- Department of Physiology, College of Korean Medicine, Daegu Haany University, Daegu, South Korea
| | - Bong Hyo Lee
- Department of Physiology, College of Korean Medicine, Daegu Haany University, Daegu, South Korea
| | - Chae Ha Yang
- Department of Physiology, College of Korean Medicine, Daegu Haany University, Daegu, South Korea
| | - Hee Young Kim
- Department of Physiology, College of Korean Medicine, Daegu Haany University, Daegu, South Korea
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Garrido-Suárez BB, Garrido G, Castro-Labrada M, Pardo-Ruíz Z, Bellma Menéndez A, Spencer E, Godoy-Figueiredo J, Ferreira SH, Delgado-Hernández R. Anti-allodynic Effect of Mangiferin in Rats With Chronic Post-ischemia Pain: A Model of Complex Regional Pain Syndrome Type I. Front Pharmacol 2018; 9:1119. [PMID: 30333751 PMCID: PMC6176059 DOI: 10.3389/fphar.2018.01119] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2018] [Accepted: 09/13/2018] [Indexed: 12/29/2022] Open
Abstract
The present study reproduces chronic post-ischemia pain (CPIP), a model of complex regional pain syndrome type I (CRPS-I), in rats to examine the possible transient and long-term anti-allodynic effect of mangiferin (MG); as well as its potential beneficial interactions with some standard analgesic drugs and sympathetic-mediated vasoconstriction and vasodilator agents during the earlier stage of the pathology. A single dose of MG (50 and 100 mg/kg, p.o.) decreased mechanical allodynia 72 h post-ischemia-reperfusion (I/R). MG 100 mg/kg, i.p. (pre- vs. post-drug) increased von Frey thresholds in a yohimbine and naloxone-sensitive manner. Sub-effective doses of morphine, amitriptyline, prazosin, clonidine and a NO donor, SIN-1, in the presence of MG were found to be significantly anti-allodynic. A long-term anti-allodynic effect at 7 and 13 days post-I/R after repeated oral doses of MG (50 and 100 mg/kg) was also observed. Further, MG decreased spinal and muscle interleukin-1β concentration and restored muscle redox status. These results indicate that MG has a transient and long-term anti-allodynic effect in CPIP rats that appears to be at least partially attributable to the opioid and α2 adrenergic receptors. Additionally, its anti-inflammatory and antioxidant mechanisms could also be implicated in this effect. The association of MG with sub-effective doses of these drugs enhances the anti-allodynic effect; however, an isobolographic analysis should be performed to define a functional interaction between them. These findings suggest the possible clinical use of MG in the treatment of CRPS-I in both early sympathetically maintained pain and long-term sympathetically independent pain.
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Affiliation(s)
- Bárbara B. Garrido-Suárez
- Laboratorio de Farmacología y Toxicología, Centro de Investigación y Desarrollo de Medicamentos, Havana, Cuba
| | - Gabino Garrido
- Departamento de Ciencias Farmacéuticas, Facultad de Ciencias, Universidad Católica del Norte, Antofagasta, Chile
| | - Marian Castro-Labrada
- Laboratorio de Farmacología y Toxicología, Centro de Investigación y Desarrollo de Medicamentos, Havana, Cuba
| | - Zenia Pardo-Ruíz
- Laboratorio de Farmacología y Toxicología, Centro de Investigación y Desarrollo de Medicamentos, Havana, Cuba
| | - Addis Bellma Menéndez
- Laboratorio de Farmacología y Toxicología, Centro de Investigación y Desarrollo de Medicamentos, Havana, Cuba
| | - Evelyn Spencer
- Laboratorio de Farmacología y Toxicología, Centro de Investigación y Desarrollo de Medicamentos, Havana, Cuba
| | - Jozi Godoy-Figueiredo
- Department of Pharmacology, Faculty of Medicine of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - Sergio H. Ferreira
- Department of Pharmacology, Faculty of Medicine of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - René Delgado-Hernández
- Centro de Estudio para las Investigaciones y Evaluaciones Biológicas, Instituto de Farmacia y Alimentos, Universidad de La Habana, Havana, Cuba
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A new hypothesis for the pathophysiology of complex regional pain syndrome. Med Hypotheses 2018; 119:41-53. [DOI: 10.1016/j.mehy.2018.07.026] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 07/18/2018] [Accepted: 07/27/2018] [Indexed: 12/21/2022]
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Effect of intra-articular Botulinum toxin injections on temporo-mandibular joint pain. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2018; 119:319-324. [DOI: 10.1016/j.jormas.2018.06.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 05/27/2018] [Accepted: 06/03/2018] [Indexed: 11/21/2022]
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do Nascimento JET, de Morais SM, de Lisboa DS, de Oliveira Sousa M, Santos SAAR, Magalhães FEA, Campos AR. The orofacial antinociceptive effect of Kaempferol-3-O-rutinoside, isolated from the plant Ouratea fieldingiana, on adult zebrafish (Danio rerio). Biomed Pharmacother 2018; 107:1030-1036. [PMID: 30257314 DOI: 10.1016/j.biopha.2018.08.089] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 08/04/2018] [Accepted: 08/15/2018] [Indexed: 01/29/2023] Open
Abstract
The aim of this study was to evaluate the antinociceptive effect of Kaempferol-3-O-rutinoside (KR), isolated from the plant Ouratea fieldingiana, on the orofacial nociception and possible mechanisms of action. Adult zebrafish (Danio rerio) were tested as a behavioral model to study formalin, glutamate, capsaicin, cinnamaldehyde and acidic saline-induced orofacial nociception, using as parameter the number of times the fish crossed the lines between the quadrants of a glass Petri dish during a specific time. Morphine was used as positive control. The effect of KR was tested for modulation by opioid (naloxone), nitrergic (L-NAME), TRPV1 (ruthenium red), TRPA1 (camphor) or ASIC (amiloride) antagonists. The effect of KR on zebrafish locomotor behavior was evaluated with the open field test. KR did not alter the fish's locomotor system and significantly reduced the orofacial nociceptive behavior induced by all noxious agents compared to the control group. The antinociceptive effect of KR was similar to morphine. All antagonists inhibited the antinociceptive effect of KR. KR has pharmacological potential for the treatment of acute orofacial pain and this effect is modulated by the opioid and nitrergic systems as well as TRPV1, TRPA1 and ASIC channels. These results can lead to the development of a new natural product for the treatment of orofacial pain and confirm the popular use of O. fieldingiana leaf for pain relief.
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Affiliation(s)
- José Eranildo Teles do Nascimento
- Programa de Pós-Graduação em Ciências Veterinárias, Núcleo de Pesquisa em Sanidade Animal, Universidade Estadual do Ceará, Brazil; Laboratório de Química de Produtos Naturais (LQPN), Universidade Estadual do Ceará, Fortaleza, Ceará, Brazil; Instituto Federal do Ceará, Campus Itapipoca, Ceará, Brazil
| | - Selene Maia de Morais
- Programa de Pós-Graduação em Ciências Veterinárias, Núcleo de Pesquisa em Sanidade Animal, Universidade Estadual do Ceará, Brazil; Laboratório de Química de Produtos Naturais (LQPN), Universidade Estadual do Ceará, Fortaleza, Ceará, Brazil.
| | - Daniele Silva de Lisboa
- Laboratório de Química de Produtos Naturais (LQPN), Universidade Estadual do Ceará, Fortaleza, Ceará, Brazil
| | - Matheus de Oliveira Sousa
- Laboratório de Química de Produtos Naturais (LQPN), Universidade Estadual do Ceará, Fortaleza, Ceará, Brazil
| | - Sacha Aubrey Alves Rodrigues Santos
- Núcleo de Biologia Experimental, Universidade de Fortaleza, Fortaleza, Ceará, Brazil; Laboratório de Bioprospecção de Produtos Naturais e Biotecnologia (LBPNB), Universidade Estadual do Ceará (UECE), Tauá, Ceará, Brazil
| | - Francisco Ernani Alves Magalhães
- Núcleo de Biologia Experimental, Universidade de Fortaleza, Fortaleza, Ceará, Brazil; Laboratório de Bioprospecção de Produtos Naturais e Biotecnologia (LBPNB), Universidade Estadual do Ceará (UECE), Tauá, Ceará, Brazil
| | - Adriana Rolim Campos
- Núcleo de Biologia Experimental, Universidade de Fortaleza, Fortaleza, Ceará, Brazil
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Patil MJ, Hovhannisyan AH, Akopian AN. Characteristics of sensory neuronal groups in CGRP-cre-ER reporter mice: Comparison to Nav1.8-cre, TRPV1-cre and TRPV1-GFP mouse lines. PLoS One 2018; 13:e0198601. [PMID: 29864146 PMCID: PMC5986144 DOI: 10.1371/journal.pone.0198601] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 05/22/2018] [Indexed: 12/19/2022] Open
Abstract
Peptidergic sensory neurons play a critical role in nociceptive pathways. To precisely define the function and plasticity of sensory neurons in detail, new tools such as transgenic mouse models are needed. We employed electrophysiology and immunohistochemistry to characterize in detail dorsal root ganglion (DRG) neurons expressing an inducible CGRPcre-ER (CGRP-cre+); and compared them to DRG neurons expressing Nav1.8cre (Nav1.8-cre+), TRPV1cre (TRPV1-cre+) and TRPV1-GFP (V1-GFP+). Tamoxifen effectively induced CGRPcre-ER production in DRG. ≈87% of CGRPcre-ER-expressing neurons were co-labeled CGRP antibody. Three small and two medium-large-sized (5HT3a+/NPY2R- and NPY2R+) neuronal groups with unique electrophysiological profiles were CGRP-cre+. Nav1.8-cre+ neurons were detected in all CGRP-cre+ groups, as well as in 5 additional neuronal groups: MrgprD+/TRPA1-, MrgprD+/TRPA1+, TRPV1+/CGRP-, vGLUT3+ and ≈30% of trkC+ neurons. Differences between TRPV1cre and Nav1.8cre reporters were that unlike TRPV1-cre+, Nav1.8-cre+ expression was detected in non-nociceptive vGLUT3+ and trkC+ populations. Many TRPV1-cre+ neurons did not respond to capsaicin. In contrast, V1-GFP+ neurons were in 4 groups, each of which was capsaicin-sensitive. Finally, none of the analyzed reporter lines showed cre-recombination in trkB+, calbindin+, 70% of trkC+ or parvalbumin+ neurons, which together encompassed ≈20% of Nav1.8-cre- DRG neurons. The data presented here increases our knowledge of peptidergic sensory neuron characteristics, while showing the efficiency and specificity manipulation of peptidergic neurons by the CGRPcre-ER reporter. We also demonstrate that manipulation of all C- and A-nociceptors is better achieved with TRPV1-cre reporter. Finally, the described approach for detailed characterization of sensory neuronal groups can be applied to a variety of reporter mice.
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Affiliation(s)
- Mayur J. Patil
- Departments of Endodontics, University of Texas Health Science Center at San Antonio, San Antonio, Texas, United States of America
| | - Anahit H. Hovhannisyan
- Departments of Endodontics, University of Texas Health Science Center at San Antonio, San Antonio, Texas, United States of America
| | - Armen N. Akopian
- Departments of Endodontics, University of Texas Health Science Center at San Antonio, San Antonio, Texas, United States of America
- Departments of Pharmacology, University of Texas Health Science Center at San Antonio, San Antonio, Texas, United States of America
- * E-mail:
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Linagliptin attenuates chronic post-ischemia pain: Possible anti-inflammatory and anti-oxidant mechanisms. Eur J Pharmacol 2018; 828:110-118. [DOI: 10.1016/j.ejphar.2018.03.039] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 03/27/2018] [Accepted: 03/28/2018] [Indexed: 02/08/2023]
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Lo Vecchio S, Andersen HH, Arendt-Nielsen L. The time course of brief and prolonged topical 8% capsaicin-induced desensitization in healthy volunteers evaluated by quantitative sensory testing and vasomotor imaging. Exp Brain Res 2018; 236:2231-2244. [DOI: 10.1007/s00221-018-5299-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 05/23/2018] [Indexed: 12/13/2022]
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Dose-response study of topical allyl isothiocyanate (mustard oil) as a human surrogate model of pain, hyperalgesia, and neurogenic inflammation. Pain 2018; 158:1723-1732. [PMID: 28614189 DOI: 10.1097/j.pain.0000000000000979] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Despite being a ubiquitous animal pain model, the natural TRPA1-agonist allyl isothiocyanate (AITC, also known as "mustard oil") has only been sparsely investigated as a potential human surrogate model of pain, sensitization, and neurogenic inflammation. Its dose-response as an algogenic, sensitizing irritant remains to be elucidated in human skin. Three concentrations of AITC (10%, 50%, and 90%) and vehicle (paraffin) were applied for 5 minutes to 3 × 3 cm areas on the volar forearms in 14 healthy volunteers, and evoked pain intensity (visual analog scale 0-100 mm) and pain quality were assessed. In addition, a comprehensive battery of quantitative sensory tests was conducted, including assessment of mechanical and thermal sensitivity. Neurogenic inflammation was quantified using full-field laser perfusion imaging. Erythema and hyperpigmentation were assessed before, immediately after, and ≈64 hours after AITC exposure. AITC induced significant dose-dependent, moderate-to-severe spontaneous burning pain, mechanical and heat hyperalgesia, and dynamic mechanical allodynia (P < 0.05). No significant differences in induced pain hypersensitivity were observed between the 50% and 90% AITC concentrations. Acute and prolonged inflammation was evoked by all concentrations, and assessments by full-field laser perfusion imaging demonstrated a significant dose-dependent increase with a ceiling effect from 50% to 90%. Topical AITC application produces pain and somatosensory sensitization in a dose-dependent manner with optimal concentrations recommended to be >10% and ≤50%. The model is translatable to humans and could be useful in pharmacological proof-of-concept studies of TRPA1-antagonists, analgesics, and anti-inflammatory compounds or for exploratory clinical purposes, eg, loss- or gain-of-function in peripheral neuropathies.
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Li WW, Guo TZ, Shi X, Birklein F, Schlereth T, Kingery WS, Clark JD. Neuropeptide regulation of adaptive immunity in the tibia fracture model of complex regional pain syndrome. J Neuroinflammation 2018; 15:105. [PMID: 29642930 PMCID: PMC5896028 DOI: 10.1186/s12974-018-1145-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 04/02/2018] [Indexed: 11/17/2022] Open
Abstract
Background Both dysfunctional neuropeptide signaling and immune system activation are characteristic of complex regional pain syndrome (CRPS). Unknown is whether substance P (SP) or calcitonin gene-related peptide (CGRP) support autoantibody production and, consequently, nociceptive sensitization. Methods These experiments involved the use of a well-characterized tibia fracture model of CRPS. Mice deficient in SP expression (Tac1−/−) and CGRP signaling (RAMP1−/−) were used to probe the neuropeptide dependence of post-fracture sensitization and antibody production. The deposition of IgM in the spinal cord, sciatic nerves, and skin was followed using Western blotting, as was expression of the CRPS-related autoantigen cytokeratin 16 (Krt16). Passive serum transfer to B-cell-deficient muMT mice was used to assess the production of functional autoantibodies in CRPS model mice. The use of immunohistochemistry allowed us to assess neuropeptide-containing fiber distribution and Langerhans cell abundance in mouse and human CRPS patient skin, while Langerhans cell-deficient mice were used to assess the functional contributions of these cells. Results Functional SP and CGRP signaling were required both for the full development of nociceptive sensitization after fracture and the deposition of IgM in skin and neural tissues. Furthermore, the passive transfer of serum from wildtype but not neuropeptide-deficient mice to fractured muMT mice caused enhanced allodynia and postural unweighting. Langerhans cells were increased in number in the skin of fracture mice and CRPS patients, and those increases in mice were reduced in neuropeptide signaling-deficient animals. Unexpectedly, Langerhans cell-deficient mice showed normal nociceptive sensitization after fracture. However, the increased expression of Krt16 after tibia fracture was not seen in neuropeptide-deficient mice. Conclusions Collectively, these data support the hypothesis that neuropeptide signaling in the fracture limb of mice is required for autoantigenic IgM production and nociceptive sensitization. The mechanism may be related to neuropeptide-supported autoantigen expression.
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Affiliation(s)
- Wen-Wu Li
- Anesthesiology Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA.,Department of Anesthesia, Stanford University School of Medicine, Stanford, CA, USA
| | - Tian-Zhi Guo
- Palo Alto Veterans Institute for Research, Palo Alto, CA, USA
| | - Xiaoyou Shi
- Anesthesiology Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA.,Department of Anesthesia, Stanford University School of Medicine, Stanford, CA, USA
| | - Frank Birklein
- Department of Neurology, University Medical Center, Mainz, Germany
| | - Tanja Schlereth
- Department of Neurology, University Medical Center, Mainz, Germany.,Department of Neurology, DKD Helios Klinik Wiesbaden, Wiesbaden, Germany
| | - Wade S Kingery
- Palo Alto Veterans Institute for Research, Palo Alto, CA, USA
| | - J David Clark
- Anesthesiology Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA. .,Department of Anesthesia, Stanford University School of Medicine, Stanford, CA, USA.
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