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Gornik HL, Aronow HD, Goodney PP, Arya S, Brewster LP, Byrd L, Chandra V, Drachman DE, Eaves JM, Ehrman JK, Evans JN, Getchius TSD, Gutiérrez JA, Hawkins BM, Hess CN, Ho KJ, Jones WS, Kim ESH, Kinlay S, Kirksey L, Kohlman-Trigoboff D, Long CA, Pollak AW, Sabri SS, Sadwin LB, Secemsky EA, Serhal M, Shishehbor MH, Treat-Jacobson D, Wilkins LR. 2024 ACC/AHA/AACVPR/APMA/ABC/SCAI/SVM/SVN/SVS/SIR/VESS Guideline for the Management of Lower Extremity Peripheral Artery Disease: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol 2024; 83:2497-2604. [PMID: 38752899 DOI: 10.1016/j.jacc.2024.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/23/2024]
Abstract
AIM The "2024 ACC/AHA/AACVPR/APMA/ABC/SCAI/SVM/SVN/SVS/SIR/VESS Guideline for the Management of Lower Extremity Peripheral Artery Disease" provides recommendations to guide clinicians in the treatment of patients with lower extremity peripheral artery disease across its multiple clinical presentation subsets (ie, asymptomatic, chronic symptomatic, chronic limb-threatening ischemia, and acute limb ischemia). METHODS A comprehensive literature search was conducted from October 2020 to June 2022, encompassing studies, reviews, and other evidence conducted on human subjects that was published in English from PubMed, EMBASE, the Cochrane Library, CINHL Complete, and other selected databases relevant to this guideline. Additional relevant studies, published through May 2023 during the peer review process, were also considered by the writing committee and added to the evidence tables where appropriate. STRUCTURE Recommendations from the "2016 AHA/ACC Guideline on the Management of Patients With Lower Extremity Peripheral Artery Disease" have been updated with new evidence to guide clinicians. In addition, new recommendations addressing comprehensive care for patients with peripheral artery disease have been developed.
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Gornik HL, Aronow HD, Goodney PP, Arya S, Brewster LP, Byrd L, Chandra V, Drachman DE, Eaves JM, Ehrman JK, Evans JN, Getchius TSD, Gutiérrez JA, Hawkins BM, Hess CN, Ho KJ, Jones WS, Kim ESH, Kinlay S, Kirksey L, Kohlman-Trigoboff D, Long CA, Pollak AW, Sabri SS, Sadwin LB, Secemsky EA, Serhal M, Shishehbor MH, Treat-Jacobson D, Wilkins LR. 2024 ACC/AHA/AACVPR/APMA/ABC/SCAI/SVM/SVN/SVS/SIR/VESS Guideline for the Management of Lower Extremity Peripheral Artery Disease: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation 2024; 149:e1313-e1410. [PMID: 38743805 DOI: 10.1161/cir.0000000000001251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
AIM The "2024 ACC/AHA/AACVPR/APMA/ABC/SCAI/SVM/SVN/SVS/SIR/VESS Guideline for the Management of Lower Extremity Peripheral Artery Disease" provides recommendations to guide clinicians in the treatment of patients with lower extremity peripheral artery disease across its multiple clinical presentation subsets (ie, asymptomatic, chronic symptomatic, chronic limb-threatening ischemia, and acute limb ischemia). METHODS A comprehensive literature search was conducted from October 2020 to June 2022, encompassing studies, reviews, and other evidence conducted on human subjects that was published in English from PubMed, EMBASE, the Cochrane Library, CINHL Complete, and other selected databases relevant to this guideline. Additional relevant studies, published through May 2023 during the peer review process, were also considered by the writing committee and added to the evidence tables where appropriate. STRUCTURE Recommendations from the "2016 AHA/ACC Guideline on the Management of Patients With Lower Extremity Peripheral Artery Disease" have been updated with new evidence to guide clinicians. In addition, new recommendations addressing comprehensive care for patients with peripheral artery disease have been developed.
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Kanai A, Ara M, Saito R, Mishima T, Takahashi Y. Subcutaneous injection of lidocaine around ischemic ankle provides safe and effective foot analgesia in patients with critical limb ischemia. Vascular 2024:17085381241238841. [PMID: 38452400 DOI: 10.1177/17085381241238841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
Abstract
OBJECTIVE It is often difficult to alleviate foot pain associated with critical limb ischemia (CLI) using common analgesics. Neuraxial block is contraindicated in anticoagulant therapy. This study was designed to determine the response to subcutaneous injection of lidocaine around the network of peripheral nerves around the ankle in patients with CLI pain on anticoagulants and antiplatelets. METHODS Sixteen patients with CLI pain in the foot were enrolled in this double-blind placebo-controlled crossover study. Patients were randomized to receive either 2% lidocaine or saline via catheters inserted into the subcutaneous area around the ankle. After recurrence of pain, the patients were crossed over to receive the alternative treatment. Pain was assessed with a numerical rating scale (NRS) before and 15 min after injection. Patients used a descriptive scale to grade pain control and were asked to determine the duration of analgesia in each arm of the study. RESULTS No serious complications including protracted bleeding occurred. Lidocaine significantly decreased the NRS on movement from 10 (6, 10) [median (range)] to 2 (0, 10) (p < .001), and the differences in the Δ change in NRS between lidocaine and placebo were significant (p = .009). Of the 16 patients, 14 patients were very satisfied after lidocaine but only one described the same after saline. The effect of lidocaine and placebo lasted 11 (0, 28) and 1 (0, 22) h, respectively. CONCLUSION Subcutaneous injection of lidocaine around the ischemic ankle affectively alleviated pain in patients with CLI without serious adverse effects under anticoagulant therapy.
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Affiliation(s)
- Akifumi Kanai
- Department of Research and Development Centre for New Medical Frontiers, Kitasato University School of Medicine, Sagamihara, Japan
| | - Masatomo Ara
- Department of Anesthesiology, Kitasato University School of Medicine, Sagamihara, Japan
| | - Ryusei Saito
- Department of Anesthesiology, Kitasato University School of Medicine, Sagamihara, Japan
| | - Toshiaki Mishima
- Department of Cardiovascular Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - Yuichiro Takahashi
- Department of Anesthesiology, Kitasato University School of Medicine, Sagamihara, Japan
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Kazemipoor M, Moradi H, Mokhtari F, Kheirollahi K. Assessing the occurrence and severity of pre- and postendodontic pain in anemic and healthy female patients. Clin Exp Dent Res 2023; 9:1122-1128. [PMID: 37849023 PMCID: PMC10728548 DOI: 10.1002/cre2.799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 10/03/2023] [Indexed: 10/19/2023] Open
Abstract
OBJECTIVES The objective of this current survey was to assess both the occurrence and severity of pre- and post-endodontic pain among female individuals, distinguishing between those with anemia and those without. MATERIALS AND METHODS In the current study, we included a total of 60 women with anemia (hemoglobin < 11) and those without anemia (hemoglobin > 13). We recorded the occurrence and severity of pain before and at 24, 48, and 72 h following root canal treatment using a visual analog scale (VAS) ranging from 0 to 10. Additionally, we collected data on patient age, tooth type, as well as pulpal and periapical conditions. Statistical analysis was carried out using two-way ANOVA, pairedt-tests, and Pearson correlation coefficient. The significance level for statistical tests was set at p ≤ .05. RESULTS The incidence of preoperative pain in both anemic and non-anemic patients was 80%. The total incidence of post-operative pain was recorded as 71.7% (82.2% in anemic and 61.1% in non-anemic women). Compared with the pretreatment pain incidence and intensity, the values increased in 24 h but declined in 48 h and 72 h after treatment. Considering the posttreatment pain intensity, the mean values were higher in the three time intervals (24, 48, and 72 h) in anemic patients. Pulpal and periapical status, in contrast to age and tooth type, significantly contributed to the intensity of posttreatment pain. CONCLUSION Regarding the importance of pain phenomenon in human life, it is recommended to consider anemia as an important risk factor for post-endodontic pain. Early diagnosis and analgesic treatment interventions in anemic females, alongside the pain control during root canal treatment, could promote the patient's satisfaction and quality of care.
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Affiliation(s)
- Maryam Kazemipoor
- Department of Endodontics, School of DentistryShahid Sadoughi University of Medical SciencesYazdIran
| | - Hooman Moradi
- Department of Endodontics, School of DentistryShahid Sadoughi University of Medical SciencesYazdIran
| | - Fatemeh Mokhtari
- Department of Endodontics, School of DentistryShahid Sadoughi University of Medical SciencesYazdIran
| | - Khatereh Kheirollahi
- Department of Oral Medicine, School of DentistryShahid Sadoughi University of Medical SciencesYazdIran
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Tadokoro Y, Takeda D, Saito I, Yatagai N, Kakei Y, Akashi M, Hasegawa T. The Efficacy of Carbon Dioxide Paste in Alleviating Pain in Patients After Neck Dissection: Protocol for a Double-Blinded, Randomized Controlled Trial. JMIR Res Protoc 2023; 12:e50500. [PMID: 37955944 PMCID: PMC10682928 DOI: 10.2196/50500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 10/19/2023] [Accepted: 10/20/2023] [Indexed: 11/14/2023] Open
Abstract
BACKGROUND Head and neck cancers that cause severe aesthetic and functional disorders normally metastasize to the cervical lymph nodes. Patients with cervical lymph node metastasis are undergoing neck dissection. Shoulder complaints are common after neck dissection, with patients reporting symptoms such as pain, weakness, shoulder droop, and disability. However, no safe and effective treatment is available for this condition at present. We will conduct a double-blinded, randomized controlled trial to evaluate the efficacy of carbon dioxide (CO2) paste in relieving pain in patients after neck dissection. OBJECTIVE This will be the first clinical study to compare the efficacy of CO2 paste with placebo in relieving postoperative pain in patients who underwent neck dissection. METHODS We will perform this trial at the Kobe University Hospital in Japan. Patients will be randomized 1:1 into the CO2 paste and control groups. Patients in the CO2 paste group will have the CO2 paste applied to the cervical surface skin for 10 minutes once per day for 14 consecutive days. The primary end point of the study is a change in the visual analog scale (VAS) scores of neck pain from baseline on day 1 (preapplication) to the end of drug application (day 15). Secondary end points include changes in the following parameters from baseline on day 1 to the end of drug application (day 15) or the study (day 29): neck pain VAS score (days 1-29), grip strength (days 1-15 and 1-29), VAS scores for subjective symptoms (the feeling of strangulation, numbness, swelling, and warmth in the neck and shoulder region) for days 1-15 and 1-29, whether the VAS score improved more than 30% (days 1-15), the arm abduction test (days 1-15 and 1-29), shoulder range of motion (abduction and flexion) for days 1-15 and 1-29, occurrence of skin disorders, and occurrence of serious side effects. Periodic monitoring will be conducted for participants during the trial. This study was approved by the certified review board of Kobe University. RESULTS The intervention commenced in May 2021 and will continue until March 2024. The collected data will provide information on the efficacy of the CO2 paste treatment. The primary end point will be compared using the Wilcoxon test, with the 1-sided significance level set at 5%. Each evaluation item will be summarized. Secondary efficacy end points will be analyzed to provide additional insights into the primary analysis. Findings based on the treatment effects are expected to be submitted for publication in 2025. CONCLUSIONS This trial will provide exploratory evidence of the efficacy and safety of CO2 paste in relieving pain in patients after neck dissection. TRIAL REGISTRATION Japan Registry of Clinical Trials (jRCT) identifier: jRCTs051210028; https://jrct.niph.go.jp/en-latest-detail/jRCTs051210028. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/50500.
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Affiliation(s)
- Yoshiaki Tadokoro
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Daisuke Takeda
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Izumi Saito
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Nanae Yatagai
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yasumasa Kakei
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Masaya Akashi
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takumi Hasegawa
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
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Noikham A, Tivirach W, Pongraweewan O, Suphathamwit A, Puangpunngam N, Jirativanont T. Popliteal sciatic nerve block for high-risk patients undergoing lower limb angioplasty: A prospective double-blinded randomized controlled trial. Medicine (Baltimore) 2023; 102:e33690. [PMID: 37145010 PMCID: PMC10158915 DOI: 10.1097/md.0000000000033690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 04/13/2023] [Indexed: 05/06/2023] Open
Abstract
BACKGROUND To assess the rate of conversion to general anesthesia, sedative and analgesic drug-sparing effects, and complications of popliteal sciatic nerve block (PSNB) compared with a sham block during lower limb angioplasty. METHODS A randomized, controlled, double-blinded trial of patients with chronic limb-threatening ischemia (CLTI) who receive PSNB with 0.25% levobupivacaine 20 mL compared with a sham block (control) during lower limb angioplasty. Pain scores, conversion rate to general anesthesia, amount of sedoanalgesia drug usage, complications, and satisfaction with the anesthesia technique by surgeons and patients were assessed. RESULTS Forty patients were enrolled in this study. Two of 20 (10%) control group patients were converted to general anesthesia, while none of the patients in the intervention group required general anesthesia (P = .487). Pain scores before PSNB did not differ between the groups (P = .771). After the block, pain scores in the block group were lower than those in the control group: 0 (0, 1.5) (median, interquartile range) and 2.5 (0.5, 3.5), respectively (P = .024). The analgesic effect persisted until immediately after the surgery (P = .035). There was no difference in pain scores at the 24-hours follow-up visit (P = .270). The total propofol and fentanyl dosage requirements, a number of patients who required propofol and fentanyl, side effects, and satisfaction were not different between the groups. No major complications were noted. CONCLUSIONS PSNB provided effective pain relief during and immediately after lower limb angioplasty, but did not statistically affect the rate of conversion to general anesthesia, sedoanalgesia drug usage, or complications.
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Affiliation(s)
- Alif Noikham
- Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Wannapa Tivirach
- Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Orawan Pongraweewan
- Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Aphichat Suphathamwit
- Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Nattawut Puangpunngam
- Division of Vascular Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Tachawan Jirativanont
- Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Sharma A, Behl T, Sharma L, Shah OP, Yadav S, Sachdeva M, Rashid S, Bungau SG, Bustea C. Exploring the molecular pathways and therapeutic implications of angiogenesis in neuropathic pain. Biomed Pharmacother 2023; 162:114693. [PMID: 37062217 DOI: 10.1016/j.biopha.2023.114693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Revised: 03/26/2023] [Accepted: 04/10/2023] [Indexed: 04/18/2023] Open
Abstract
Recently, much attention has been paid to chronic neuro-inflammatory condition underlying neuropathic pain. It is generally linked with thermal hyperalgesia and tactile allodynia. It results due to injury or infection in the nervous system. The neuropathic pain spectrum covers a variety of pathophysiological states, mostly involved are ischemic injury viral infections associated neuropathies, chemotherapy-induced peripheral neuropathies, autoimmune disorders, traumatic origin, hereditary neuropathies, inflammatory disorders, and channelopathies. In CNS, angiogenesis is evident in inflammation of neurons and pain in bone cancer. The role of chemokines and cytokines is dualistic; their aggressive secretion produces detrimental effects, leading to neuropathic pain. However, whether the angiogenesis contributes and exists in neuropathic pain remains doubtful. In the present review, we elucidated summary of diverse mechanisms of neuropathic pain associated with angiogenesis. Moreover, an overview of multiple targets that have provided insights on the VEGF signaling, signaling through Tie-1 and Tie-2 receptor, erythropoietin pathway promoting axonal growth are also discussed. Because angiogenesis as a result of these signaling, results in inflammation, we focused on the mechanisms of neuropathic pain. These factors are mainly responsible for the activation of post-traumatic regeneration of the PNS and CNS. Furthermore, we also reviewed synthetic and herbal treatments targeting angiogenesis in neuropathic pain.
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Affiliation(s)
- Aditi Sharma
- School of Pharmaceutical Sciences, Shoolini University, Solan 173211, Himachal Pradesh, India
| | - Tapan Behl
- School of Health Sciences and Technology, University of Petroleum and Energy Studies, Bidholi, 248007 Dehradun, Uttarakhand, India.
| | - Lalit Sharma
- School of Pharmaceutical Sciences, Shoolini University, Solan 173211, Himachal Pradesh, India
| | - Om Prakash Shah
- School of Pharmaceutical Sciences, Shoolini University, Solan 173211, Himachal Pradesh, India
| | - Shivam Yadav
- Department of Pharmaceutical Sciences, School of Pharmaceutical Sciences, Chhatrapati Shahu ji Maharaj University, Kanpur 208024, Uttar Pradesh, India
| | - Monika Sachdeva
- Fatima College of Health Sciences, Al Ain 00000, United Arab Emirates
| | - Summya Rashid
- Department of Pharmacology & Toxicology, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Al-Kharj 11942, Saudi Arabia
| | - Simona Gabriela Bungau
- Department of Pharmacy, Faculty of Medicine and Pharmacy, University of Oradea, Oradea 410028, Romania; Doctoral School of Biomedical Sciences, University of Oradea, Oradea 410028, Romania.
| | - Cristiana Bustea
- Department of Preclinical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, Oradea 410073, Romania
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Yatagai N, Hasegawa T, Kyotani K, Noda T, Amano R, Saito I, Arimoto S, Takeda D, Kakei Y, Akashi M. Exploratory clinical trial to evaluate the efficacy and safety of carbon dioxide paste in healthy people. Medicine (Baltimore) 2022; 101:e29511. [PMID: 35866800 PMCID: PMC9302358 DOI: 10.1097/md.0000000000029511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
INTRODUCTION Scarring and pain are postoperative complications in patients after head and neck cancer treatment; however, there is no effective treatment. These complications are affected by local blood flow disorders, and it is well known that the transcutaneous application of carbon dioxide (CO2) improves local blood flow. Previously, we have shown that the transcutaneous application of carbon dioxide causes absorption of CO2 and increase the oxygen (O2) pressure in the treated tissue; it is expected that the application of CO2 may reduce scarring and pain caused by cancer treatment. We newly introduced the CO2 paste as a new CO2 application method, which does not need to use CO2 gas directly. In this study, we aimed to apply of CO2 paste to healthy people and to investigate its usefulness, safety and feasibility by analysing the increase in blood flow and frequency of adverse events. METHODS We applied carbon dioxide paste to skin over the sternocleidomastoid and gastrocnemius muscles of eight healthy volunteers. The changes in blood flow before and after the CO2 paste application using dynamic MRI, and changes in the vital signs were evaluated. RESULTS In the neck area and middle layer of the lower leg, the signal intensity (SI) significantly increased 60 seconds after application. In the surface layer of the lower leg, the SI was significantly increased 60 and 300 seconds after paste application. Although mild heat was noted after the paste application, no obvious adverse events occurred. CONCLUSION We demonstrated the increase in SI by dynamic MRI at the site of the carbon dioxide paste application, which indicates the paste application is effective in improving the blood flow.
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Affiliation(s)
- Nanae Yatagai
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Takumi Hasegawa
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
- *Correspondence: Takumi Hasegawa, Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan (e-mail: )
| | - Katsusuke Kyotani
- Center for Radiology and Radiation Oncology, Kobe University Hospital, Kobe, Japan
| | - Tomohiro Noda
- Center for Radiology and Radiation Oncology, Kobe University Hospital, Kobe, Japan
| | - Rika Amano
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Izumi Saito
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Satomi Arimoto
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Daisuke Takeda
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Yasumasa Kakei
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Masaya Akashi
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
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Fernández-Ginés FD, Cortiñas-Saenz M, Agudo-Ponce D, Morales-Molina JA, Sánchez CF, Sierra-Garcia F. Pain management & opioid dose reduction with topical sevoflurane instillations in intractable venous ulcers: a case report. BRAZ J PHARM SCI 2022. [DOI: 10.1590/s2175-97902020000318681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Heidari M, Zolaktaf V, Ghasemi G, Nejadian SL. Integrated Exercise and Glycemic and Peripheral Sensation Control in Diabetic Neuropathy: A Single-Blind, Randomized Controlled Trial. Int J Prev Med 2021; 12:169. [PMID: 35070202 PMCID: PMC8724797 DOI: 10.4103/ijpvm.ijpvm_306_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 11/28/2020] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Neuropathy control and management is an objective in therapeutic exercises prescribed for patients with Type 2 diabetic peripheral neuropathy. We examined the effects of 12-week integrated exercise (IE) on glycemic control and peripheral sensation criteria in patients with diabetic neuropathy. METHODS This study was carried out in 2019-2020 in Janan diabetic society of Najaf Abad in Iran. Based on MNSI scores, we assigned 40 patients into two equal paired random groups (control vs. IE). Pre and posttests were administered before and after three months of intervention. RESULTS Repeated measures ANOVA showed no significant interaction effect between the FBS of the groups (P = 0.26) but significant interaction effects were observed between the levels of 2 hrs pp G, 4 pm G, HbA1c, Diapason, Monofilament, and Thermofeel in favor of the IE group (P < 0.05). CONCLUSIONS At the beginning of IE, we used massage and foam roller to release pain and improve blood circulation as well as sensation in the neuropathic areas. This may have helped the patients perform the aerobic and resistance exercises more easily. Therefore, better glycemic control and peripheral sensation were achieved. Verification of the long-term effects of this training strategy requires further study. Verification of the long-term effects of this training strategy requires further study.
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Affiliation(s)
- Masoome Heidari
- Department of Sport Injuries and Corrective Exercises, Faculty of Exercise Sciences, University of Isfahan, Isfahan, Iran
| | - Vahid Zolaktaf
- Department of Sport Injuries and Corrective Exercises, Faculty of Exercise Sciences, University of Isfahan, Isfahan, Iran
| | - Gholamali Ghasemi
- Department of Sport Injuries and Corrective Exercises, Faculty of Exercise Sciences, University of Isfahan, Isfahan, Iran
| | - Shahram Lenjan Nejadian
- Department of Sport Injuries and Corrective Exercises, Faculty of Exercise Sciences, University of Isfahan, Isfahan, Iran
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Leriche Syndrome Misdiagnosed as Complex Regional Pain Syndrome in a Patient with Neuropathic Pain Caused by a Chip Fracture: A Case Report. ACTA ACUST UNITED AC 2021; 57:medicina57050486. [PMID: 34066172 PMCID: PMC8150991 DOI: 10.3390/medicina57050486] [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: 03/19/2021] [Revised: 05/07/2021] [Accepted: 05/10/2021] [Indexed: 11/26/2022]
Abstract
Introduction: Leriche syndrome is an aortoiliac occlusive disease caused by atherosclerotic occlusion. We report a case of Leriche syndrome with a fracture that was suspected as complex regional pain syndrome (CRPS), as the post-traumatic pain gradually worsened in the form of excruciating neuropathic pain. Case Report: A 52-year-old woman with a history of hypertension was referred to the Department of Pain Medicine from a local orthopedic clinic because of suspected CRPS for excruciating neuropathic pain for one month. She complained of gait dysfunction and severe pain in the right foot following an incident of trauma with the right first toe. The average pain intensity assessed using the visual analog scale (VAS) was 90 (0: no pain, 100: the worst pain imaginable), and the neuropathic pain was evident as a score of 6/10 on Douleur neuropathique 4. Allodynia, hyperalgesia, blue discoloration of the skin, asymmetric temperature change (1.38 °C), and edematous soft tissue changes were observed. Ultrasonography showed a chip fracture in the first distal phalanx of the right first toe. The diagnosis was most probably CRPS type I according to the Budapest research criteria for CRPS. However, multiple pain management techniques were insufficient in controlling the symptoms. A month and a half later, an ankle-brachial index score of less than 0.4 suggested severe peripheral artery disease. Computed tomography angiography showed total occlusion between the infrarenal abdominal aorta and the bilateral common iliac arteries. Therefore, she underwent aortic-bifemoral bypass surgery with a diagnosis of Leriche syndrome. Three months after the surgery, the average pain intensity was graded as 10 on the VAS (0–100), the color of the skin of the right first toe improved and no gait dysfunction was observed. Conclusion: A chip fracture in a region with insufficient blood flow could manifest as excruciating neuropathic pain in Leriche syndrome.
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Jiang X, Yuan Y, Ma Y, Zhong M, Du C, Boey J, Armstrong DG, Deng W, Duan X. Pain Management in People with Diabetes-Related Chronic Limb-Threatening Ischemia. J Diabetes Res 2021; 2021:6699292. [PMID: 34046505 PMCID: PMC8128546 DOI: 10.1155/2021/6699292] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 04/19/2021] [Accepted: 05/03/2021] [Indexed: 12/24/2022] Open
Abstract
Management of neuropathic pain in people with diabetes has been widely investigated. However, little attention was paid to address ischemic-related pain in patients with diabetes mellitus who suffered from chronic limb-threatening ischemia (CLTI), the end stage of lower extremity arterial disease (LEAD). Pain management has a tremendous influence on patients' quality of life and prognosis. Poor management of this type of pain owing to the lack of full understanding undermines patients' physical and mental quality of life, which often results in a grim prognosis, such as depression, myocardial infarction, lower limb amputation, and even mortality. In the present article, we review the current strategy in the pain management of diabetes-related CLTI. The endovascular therapy, pharmacological therapies, and other optional methods could be selected following comprehensive assessments to mitigate ischemic-related pain, in line with our current clinical practice. It is very important for clinicians and patients to strengthen the understanding and build intervention strategy in ischemic pain management and possible adverse consequence.
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Affiliation(s)
- Xiaoyan Jiang
- Department of Endocrinology, Diabetic Foot Center, Chongqing University Central Hospital, Chongqing Emergency Medical Center, Chongqing 400014, China
| | - Yi Yuan
- Department of Endocrinology, Diabetic Foot Center, Chongqing University Central Hospital, Chongqing Emergency Medical Center, Chongqing 400014, China
| | - Yu Ma
- Department of Endocrinology, Diabetic Foot Center, Chongqing University Central Hospital, Chongqing Emergency Medical Center, Chongqing 400014, China
| | - Miao Zhong
- Department of Endocrinology, Diabetic Foot Center, Chongqing University Central Hospital, Chongqing Emergency Medical Center, Chongqing 400014, China
| | - Chenzhen Du
- Department of Endocrinology, Diabetic Foot Center, Chongqing University Central Hospital, Chongqing Emergency Medical Center, Chongqing 400014, China
| | - Johnson Boey
- Department of Podiatry, National University of Hospital Singapore, Singapore 169608
| | - David G. Armstrong
- Keck School of Medicine of University of Southern California, Los Angeles, CA 90033, USA
| | - Wuquan Deng
- Department of Endocrinology, Diabetic Foot Center, Chongqing University Central Hospital, Chongqing Emergency Medical Center, Chongqing 400014, China
| | - Xiaodong Duan
- Department of Rehabilitation, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan 646000, China
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13
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Abstract
Dysesthesia is an unpleasant abnormal sensation, often accompanied by pain, paresthesia (abnormal sensation), and numbness (decrease or loss of sensation). Dysesthesia has been associated with various conditions, although its underlying mechanisms are largely unknown. This study assessed the roles of transient receptor potential ankyrin 1 (TRPA1) in dysesthesia by utilizing three animal models of dysesthesia characterized by reductions in blood flow to the skin: a transient hindlimb ischemia/reperfusion model, characterized by spontaneous licking and tactile hypoesthesia of the ischemic hindpaw; a streptozotocin-induced diabetic neuropathy model in mice, characterized by cold hypersensitivity, which is likely parallel to the reduced skin blood flow of the hindpaw; and a hindlimb ischemia model. TRPA1 inhibition or deficiency blocked spontaneous licking in the transient hindlimb ischemia/reperfusion model and cold hypersensitivity in the diabetic mouse model mice. Consistent with these results, the nocifensive behaviors induced by intraplantar injection of a TRPA1 agonist were enhanced in the diabetic neuropathy and hindlimb ischemia models. Hypoxia enhanced H2O2-induced TRPA1 responses in human TRPA1-expressing cells and cultured mouse dorsal root ganglion neurons, with this hypoxia-induced TRPA1 sensitization to H2O2 being associated with hypoxia-induced inhibition of the hydroxylation of prolyl hydroxylases. These results suggest that dysesthesia following blood flow reduction is caused by the activation of TRPA1 sensitized by hypoxia and that hypoxia-induced TRPA1 sensitization plays a pivotal role in painful dysesthesia induced by peripheral blood flow reduction.
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Affiliation(s)
- Kanako So
- Department of Molecular Pharmacology, Graduate School of Pharmaceutical Sciences, Kyoto University
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14
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Improvement of peripheral vascular impairment by a phosphodiesterase type 5 inhibitor tadalafil prevents oxaliplatin-induced peripheral neuropathy in mice. J Pharmacol Sci 2019; 141:131-138. [PMID: 31734027 DOI: 10.1016/j.jphs.2019.10.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 10/03/2019] [Accepted: 10/23/2019] [Indexed: 12/23/2022] Open
Abstract
Oxaliplatin, a platinum-based chemotherapeutic drug, frequently induces peripheral neuropathy. Accumulating evidences suggest a possible relationship between peripheral vascular impairment and peripheral neuropathy. In this study, we investigated the effects of vasodilators on cumulative peripheral neuropathy induced by repeated injections of oxaliplatin (10 mg/kg) once a week for 8 weeks in mice. Single injections of vasodilators, including a phosphodiesterase type 5 inhibitor tadalafil acutely alleviated oxaliplatin-induced cold hypersensitivity, while tadalafil had no effect on the mechanical hypersensitivity. By contrast, long-term administration of tadalafil (0.1% in chow diets) during the oxaliplatin injection period reduced the oxaliplatin-induced decreases in skin temperature and blood flow without affecting platinum concentrations in blood, sciatic nerves, and dorsal root ganglion. The long-term administration significantly suppressed cold, mechanical, and electrical current hypersensitivities as well as thermal hypoesthesia. Furthermore, it prevented the decreases in sensory nerve conductance velocity and the number of endoneurial microvessels, and axon degeneration in the sciatic nerves. In vitro studies confirmed that tadalafil does not interfere with the cytotoxicity of oxaliplatin against human cancer cell lines. Altogether, these results suggest that improvement of peripheral vascular impairment by tadalafil could alleviate and prevent oxaliplatin-induced peripheral neuropathy.
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15
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Klinkova AS, Kamenskaya OV, Ashurkov AV, Murtazin VI, Lomivorotov VV, Karaskov AM. [Factors of adverse prediction of application of spinal cord stimulation with chronic pain syndrome in patients with critical lower limb ischemia]. Zh Nevrol Psikhiatr Im S S Korsakova 2019; 119:23-30. [PMID: 31626215 DOI: 10.17116/jnevro201911909123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM To study the clinical dynamics in the long-term period after spinal cord stimulation (SCS) in patients with chronic pain syndrome and critical lower limb ischemia (CLLI) and to identify factors affecting the prognosis of SCS. MATERIAL AND METHODS The clinical dynamics was analyzed in 48 patients with pain syndrome and CLLI 1 year after SCS. Microcirculatory blood flow (MBF) was studied in the affected foot by laser-doppler flowmetry (LDF) (Perfusion Units (PU)) and transcutaneous oximetry (TcpO2, mmHg.) using an occlusive test before and after SCS. The factors associated with negative clinical dynamics 1 year after SCS were determined. RESULTS In 74% of cases, SCS contributes to the improvement of clinical status (reduction of pain syndrome, increase in motor activity, healing of ulcers). After SCS, according to LDF and TcpO2, the authors observed an increase in MBF and tissue metabolism - from 1.3 (0.7-2.8) to 6.2 (3.8-8.7) PU and from 14.5 (7.5-22.1) to 41.1 (26.4-57.6) mmHg, respectively with normalization of the MBF reserve during the occlusion test. Negative clinical dynamics after SCS is associated with high comorbidity, TcO2 <10 mmHg and the duration of pain. CONCLUSION SCS contributes to the improvement of the clinical status of patients with chronic pain syndrome and CLLI. The negative dynamics is associated with high comorbidity, TcrO2 <10 mmHg and the duration of pain.
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Affiliation(s)
- A S Klinkova
- Meshalkin National medical research center of the Ministry of Health of the Russian Federation
| | - O V Kamenskaya
- Meshalkin National medical research center of the Ministry of Health of the Russian Federation
| | - A V Ashurkov
- Meshalkin National medical research center of the Ministry of Health of the Russian Federation
| | - V I Murtazin
- Meshalkin National medical research center of the Ministry of Health of the Russian Federation
| | - V V Lomivorotov
- Meshalkin National medical research center of the Ministry of Health of the Russian Federation
| | - A M Karaskov
- Meshalkin National medical research center of the Ministry of Health of the Russian Federation
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16
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Seretny M, Colvin LA. Pain management in patients with vascular disease. Br J Anaesth 2018; 117 Suppl 2:ii95-ii106. [PMID: 27566812 DOI: 10.1093/bja/aew212] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/04/2016] [Indexed: 12/29/2022] Open
Abstract
Vascular disease covers a wide range of conditions, including arterial, venous, and lymphatic disorders, with many of these being more common in the elderly. As the population ages, the incidence of vascular disease will increase, with a consequent increase in the requirement to manage both acute and chronic pain in this patient population. Pain management can be complex, as there are often multiple co-morbidities to be considered. An understanding of the underlying pain mechanisms is helpful in the logical direction of treatment, particularly in chronic pain states, such as phantom limb pain or complex regional pain syndrome. Acute pain management for vascular surgery presents a number of challenges, including coexisting anticoagulant medication, that may preclude the use of regional techniques. Within the limited evidence base, there is a suggestion that epidural analgesia provides better pain relief and reduced respiratory complications after major vascular surgery. For carotid endarterectomy, there is again some evidence supporting the use of local anaesthetic analgesia, either by infiltration or by superficial cervical plexus block. Chronic pain in vascular disease includes post-amputation pain, for which well-known risk factors include high pain levels before amputation and in the immediate postoperative period, emphasizing the importance of good pain control in the perioperative period. Complex regional pain syndrome is another challenging chronic pain syndrome with a wide variety of treatment options available, with the strongest evidence being for physical therapies. Further research is required to gain a better understanding of the underlying pathophysiological mechanisms in pain associated with vascular disease and the best analgesic approaches to manage it.
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Affiliation(s)
- M Seretny
- Department of Anaesthesia, Critical Care and Pain Medicine, University of Edinburgh, Western General Hospital, Crewe Road, Edinburgh EH4 2XU, UK
| | - L A Colvin
- Department of Anaesthesia, Critical Care and Pain Medicine, University of Edinburgh, Western General Hospital, Crewe Road, Edinburgh EH4 2XU, UK
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17
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Kim DS, Na HS, Lee JH, Shin YD, Shim JK, Shin HW, Kang H, Joung KW. Current clinical application of dexmedetomidine for sedation and anesthesia. Anesth Pain Med (Seoul) 2017. [DOI: 10.17085/apm.2017.12.4.306] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Affiliation(s)
- Doo Sik Kim
- Department of Anesthesiology and Pain Medicine, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan, Korea
| | - Hyo-seok Na
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seoul, Korea
| | - Ji-hyang Lee
- Department of Anesthesiology and Pain Medicine, Daegu Fatima Hospital, Daegu, Korea
| | - Young Duck Shin
- Department of Anesthesiology and Pain Medicine, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Jae-Kwang Shim
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Hye Won Shin
- Department of Anesthesiology and Pain Medicine, Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Hyoseok Kang
- Department of Anesthesiology and Pain Medicine, Eulji Hospital, Eulji University College of Medicine, Seoul, Korea
| | - Kyoung-Woon Joung
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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18
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Stanos S, Brodsky M, Argoff C, Clauw DJ, D'Arcy Y, Donevan S, Gebke KB, Jensen MP, Lewis Clark E, McCarberg B, Park PW, Turk DC, Watt S. Rethinking chronic pain in a primary care setting. Postgrad Med 2017; 128:502-15. [PMID: 27166559 DOI: 10.1080/00325481.2016.1188319] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Chronic pain substantially impacts patient function and quality of life and is a burden to society at large in terms of increased health care utilization and loss of productivity. As a result, there is an increasing recognition of chronic pain as a public health crisis. However, there remains wide variability in clinical practices related to the prevention, assessment, and treatment of chronic pain. Certain fundamental aspects of chronic pain are often neglected including the contribution of the psychological, social, and contextual factors associated with chronic pain. Also commonly overlooked is the importance of understanding the likely neurobiological mechanism(s) of the presenting pain and how they can guide treatment selection. Finally, physicians may not recognize the value of using electronic medical records to systematically capture data on pain and its impact on mood, function, and sleep. Such data can be used to monitor onset and maintenance of treatments effects at the patient level and evaluate costs at the systems level. In this review we explain how these factors play a critical role in the development of a coordinated, evidence-based treatment approach tailored to meet specific needs of the patient. We also discuss some practical approaches and techniques that can be implemented by clinicians in order to enhance the assessment and management of individuals with chronic pain in primary care settings.
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Affiliation(s)
- Steven Stanos
- a Swedish Pain Services , Swedish Health System , Seattle , WA , USA
| | - Marina Brodsky
- b Global Medical Affairs , Pfizer Inc ., New York , NY , USA
| | - Charles Argoff
- c Department of Neurology , Albany Medical Center , Albany , NY , USA
| | - Daniel J Clauw
- d Department of Anesthesiology , The University of Michigan , Ann Arbor , MI , USA
| | | | - Sean Donevan
- b Global Medical Affairs , Pfizer Inc ., New York , NY , USA
| | - Kevin B Gebke
- f Department of Family Medicine , Indiana University School of Medicine , Indianapolis , IN , USA
| | - Mark P Jensen
- g Department of Rehabilitation Medicine , University of Washington , Seattle , WA , USA
| | - Evelyn Lewis Clark
- h Warrior Centric Health, LLC , Rutgers Robert Wood Johnson Medical School , New Brunswick , NJ , USA
| | - Bill McCarberg
- i University of California San Diego , San Diego , CA , USA
| | - Peter W Park
- b Global Medical Affairs , Pfizer Inc ., New York , NY , USA
| | - Dennis C Turk
- j Department of Anesthesiology and Pain Medicine , University of Washington , Seattle , WA , USA
| | - Stephen Watt
- b Global Medical Affairs , Pfizer Inc ., New York , NY , USA
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19
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Cruccu G, Di Stefano G, Fattaposta F, Jann S, Padua L, Schenone A, Truini A. L-Acetyl-carnitine in Patients with Carpal Tunnel Syndrome: Effects on Nerve Protection, Hand Function and Pain. CNS Drugs 2017; 31:1103-1111. [PMID: 29264721 PMCID: PMC5747578 DOI: 10.1007/s40263-017-0476-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND AIM L-Acetyl-carnitine (LAC) exerts an energetic effect on nerves and muscles. Recently, preclinical experiments have demonstrated a central anti-nociceptive action. OBJECTIVE Our objective was to assess the effects of LAC on neuroprotection, pain, and function in carpal tunnel syndrome (CTS), a very frequent chronic compressive neuropathy. METHODS In a multicentre, examiner-blinded, clinical and neurophysiological 4-month study, we enrolled 82 patients and examined 120 hands with CTS of mild to moderate severity. Patients were assessed at baseline and 10, 60 and 120 days after treatment with LAC 500 mg twice daily (BID). All patients underwent a conduction study of the median nerve, the Boston Carpal Tunnel Questionnaire (BCTQ) and the Neuropathic Pain Symptom Inventory (NPSI). The primary endpoint was the sensory conduction velocity (SCV) of the median nerve. RESULTS The primary endpoint was met, with significant improvement of the SCV (P < 0.0001). All sensory neurophysiological measures also significantly improved. BCTQ score changed significantly (P < 0.0001), with a greater improvement in the symptom component. Nine of the NPSI types of pain, particularly squeezing and pressure pain and pain evoked by pressure, showed a significant reduction (P < 0.0001). CONCLUSIONS Our clinical and neurophysiological study indicated that 4 months of treatment with LAC exerted a neuroprotective effect. LAC reduced pain in patients with mild and moderate CTS, a result that is possibly due to both its neuroprotective action and its central anti-nociceptive properties. Clinical Trials Registration code: EudraCT 2014-002289-62.
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Affiliation(s)
- Giorgio Cruccu
- Department of Neurology and Psychiatry, Sapienza University, Viale Università 30, 00185, Roma, Italy.
| | - G. Di Stefano
- grid.7841.aDepartment of Neurology and Psychiatry, Sapienza University, Viale Università 30, 00185 Roma, Italy
| | - F. Fattaposta
- grid.7841.aPoliclinico Umberto I, Sapienza University, Roma, Italy
| | - S. Jann
- grid.416200.1Department of Neuroscience, Niguarda Hospital, Milano, Italy
| | - L. Padua
- 0000 0001 0941 3192grid.8142.fDepartment of Geriatrics, Neurosciences and Orthopaedics, Università Cattolica del Sacro Cuore, Rome, Italy ,Department of Neurorehabilitation, Don Carlo Gnocchi Onlus Foundation, Milan, Italy
| | - A. Schenone
- 0000 0001 2151 3065grid.5606.5Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genova, Genova, Italy
| | - A. Truini
- grid.7841.aDepartment of Neurology and Psychiatry, Sapienza University, Viale Università 30, 00185 Roma, Italy
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20
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Hypoxia-induced sensitisation of TRPA1 in painful dysesthesia evoked by transient hindlimb ischemia/reperfusion in mice. Sci Rep 2016; 6:23261. [PMID: 26983498 PMCID: PMC4794653 DOI: 10.1038/srep23261] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2015] [Accepted: 03/02/2016] [Indexed: 11/13/2022] Open
Abstract
Dysesthesia is an unpleasant abnormal sensation, which is often accompanied by peripheral neuropathy or vascular impairment. Here, we examined the roles of transient receptor potential ankyrin 1 (TRPA1) in dysesthesia-like behaviours elicited by transient hindlimb ischemia (15–60 min) by tightly compressing the hindlimb, and reperfusion by releasing the ligature. The paw-withdrawal responses to tactile stimulation were reduced during ischemia and lasted for a while after reperfusion. Hindlimb ischemia/reperfusion elicited spontaneous licking of the ischemic hindpaw that peaked within 10 min. The licking was inhibited by reactive oxygen species (ROS) scavengers, a TRPA1 antagonist, or TRPA1 deficiency, but not by TRPV1 deficiency. In human TRPA1-expressing cells as well as cultured mouse dorsal root ganglion neurons, the H2O2-evoked TRPA1 response was significantly increased by pretreatment with hypoxia (80 mmHg) for 30 min. This hypoxia-induced TRPA1 sensitisation to H2O2 was inhibited by overexpressing a catalytically-inactive mutant of prolyl hydroxylase (PHD) 2 or in a TRPA1 proline mutant resistant to PHDs. Consistent with these results, a PHD inhibitor increased H2O2-evoked nocifensive behaviours through TRPA1 activation. Our results suggest that transient hindlimb ischemia/reperfusion-evoked spontaneous licking, i.e. painful dysesthesia, is caused by ROS-evoked activation of TRPA1 sensitised by hypoxia through inhibiting PHD-mediated hydroxylation of a proline residue in TRPA1.
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21
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Venturini MA, Zappa S, Minelli C, Bonardelli S, Lamberti L, Bisighini L, Zangrandi M, Turin M, Rizzo F, Rizzolo A, Latronico N. MAGnesium-oral supplementation to reduce PAin in patients with severe PERipheral arterial occlusive disease: the MAG-PAPER randomised clinical trial protocol. BMJ Open 2015; 5:e009137. [PMID: 26674497 PMCID: PMC4691781 DOI: 10.1136/bmjopen-2015-009137] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION Magnesium exerts analgaesic effects in several animal pain models, as well as in patients affected by acute postoperative pain and neuropathic chronic pain. There is no evidence that magnesium can modulate pain in patients with peripheral arterial occlusive disease (PAOD). We describe the protocol of a single-centre randomised double-blind clinical trial aimed at assessing the efficacy of oral magnesium supplementation in controlling severe pain in patients with advanced PAOD. METHODS AND ANALYSIS Adult patients affected by PAOD at stages III and IV of Lèriche-Fontaine classification, who are opioid-naïve, and who have been admitted to our Acute Pain Service for intractable pain, will be eligible. Patients will be randomised to the control group, treated with standard therapy (oxycodone and pregabalin) plus placebo for 2 weeks, or to the experimental group (standard therapy plus magnesium oxide). Patients will be evaluated on days 0, 2, 4, 6, 8, 12 and 14; the following information will being collected: daily oxycodone dose; average and maximum pain (Numerical Rating Scale); pain relief (Pain Relief Scale); characteristics of the pain (Neuropathic Pain Scale); impact of pain on the patient's daily activities (Brief Pain Inventory). The primary outcome will be oxycodone dosage needed to achieve satisfactory analgaesia on day 14. Secondary outcomes will be pain relief on day 2, time needed to achieve satisfactory analgaesia and time needed to achieve a pain reduction of 50%. A sample size calculation was performed for the primary outcome, which estimated a required sample size of 150 patients (75 per group). ETHICS AND DISSEMINATION Ethical approval of the study protocol has been obtained from Comitato Etico Provinciale di Brescia, Brescia, Italy. Trial results will be disseminated through scientific journal manuscripts and scientific conference presentations. TRIAL REGISTRATION NUMBER NCT02455726.
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Affiliation(s)
- Monica Aida Venturini
- Department of Anesthesia, Critical Care Medicine and Emergency, University of Brescia at Spedali Civili, Brescia, Italy
| | - Sergio Zappa
- Department of Anesthesia, Critical Care Medicine and Emergency, University of Brescia at Spedali Civili, Brescia, Italy
| | - Cosetta Minelli
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Stefano Bonardelli
- Department of Surgery, University of Brescia at Spedali Civili, Brescia, Italy
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Laura Lamberti
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Luca Bisighini
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Marta Zangrandi
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Maddalena Turin
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Francesco Rizzo
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Andrea Rizzolo
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Nicola Latronico
- Department of Anesthesia, Critical Care Medicine and Emergency, University of Brescia at Spedali Civili, Brescia, Italy
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
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22
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Blanco F, Muriel C, Labrador J, Gonzalez-Porras JR, Gonzalez-Sarmiento R, Lozano FS. Influence of UGT2B7, CYP3A4, and OPRM1 Gene Polymorphisms on Transdermal Buprenorphine Pain Control in Patients with Critical Lower Limb Ischemia Awaiting Revascularization. Pain Pract 2015; 16:842-9. [PMID: 26407542 DOI: 10.1111/papr.12343] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Accepted: 06/15/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND Pain control in critical limb ischemia (CLI) varies considerably between individuals. OBJECTIVE To evaluate pharmacogenetically the response to transdermal buprenorphine (BUP-TTS) in patients with CLI who are awaiting revascularization. METHODS One hundred and seven patients with CLI were treated with BUP-TTS. The following were analyzed: (1) pain perception (visual analog scale (VAS) before and 4 days after treatment) and (2) genetics: glucuronosyltransferase (UGT2B7), cytochrome (CYP3A4), and μ-opioid receptor (OPRM1) gene polymorphisms. RESULTS Ninety-three patients completed the study. The VAS score by the fourth day of analgesia dropped from 6.82 to 3.38 (P < 0.05). The analgesic response to BUP-TTS was greater in men than in women (P = 0.019). Patients who were AA homozygotes for the CYP3A4 gene showed the best response to analgesic treatment (P = 0.003). The combination of the CYP3A4 gene with UGT2B7 or OPRM1 was favorable to the effect of the CYP3A4 gene (P = 0.045 and P = 0.026, respectively). The combination of UGT2B7 with OPRM1 was ineffective (P = 0.648). The 3 polymorphisms together had no effect on response to treatment (P = 0.461). CONCLUSIONS BUP-TTS is efficacious in the control of pain in patients with CLI. The homozygous AA carriers of the CYP3A4 gene respond better to treatment with BUP-TTS.
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Affiliation(s)
- Francisco Blanco
- General Surgery Department, Hospital Universitario de Salamanca-IBSAL, Salamanca, Spain
| | - Clemente Muriel
- Anesthesiology and Reanimation Department, Hospital Universitario de Salamanca-IBSAL, Salamanca, Spain
| | - Jorge Labrador
- Hematology Department, Hospital Universitario de Burgos, Burgos, Spain
| | | | - Rogelio Gonzalez-Sarmiento
- Molecular Medicine Unit-Medicine Department, Facultad de Medicina-IBSAL-Universidad de Salamanca-CSIC, Salamanca, Spain
| | - Francisco S Lozano
- Angiology and Vascular Surgery Department, Hospital Universitario de Salamanca-IBSAL, Salamanca, Spain
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23
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Peripheral nerve injury induces persistent vascular dysfunction and endoneurial hypoxia, contributing to the genesis of neuropathic pain. J Neurosci 2015; 35:3346-59. [PMID: 25716835 DOI: 10.1523/jneurosci.4040-14.2015] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Nerve injury is associated with microvascular disturbance; however, the role of the vascular system has not been well characterized in the context of neuropathic pain. Furthermore, ischemia is thought to play a role in a number of neuropathic pain conditions, and yet the role of hypoxia has also not been characterized in neuropathic pain conditions. In this study, we observed the presence of persistent endoneurial hypoxia in a mouse model of traumatic peripheral nerve injury, causing painful mononeuropathy. We attribute the ongoing hypoxia to microvascular dysfunction, endoneurial fibrosis, and increased metabolic requirements within the injured nerve. Increased lactate levels were observed in injured nerves, as well as increased oxygen consumption and extracellular acidification rates, suggesting that anaerobic glycolysis is required to maintain cellular ATP levels. Hypoxia causes a reduction in levels of the Na(+)/K(+) ATPase ion transporter in both cultured primary dorsal root ganglion neurons and injured peripheral nerve. A reduction of Na(+)/K(+) ATPase ion transporter levels likely contributes to the hyperexcitability of injured nerves. Physiological antagonism of hypoxia with hyperbaric oxygen alleviated mechanical allodynia in nerve-injured animals. These results suggest that hypoxia and the Na(+)/K(+) ATPase ion transporter may be a novel mechanistic target for the treatment of neuropathic pain. In addition, the findings support the possibility of using hypoxia activated pro-drugs to localize treatments for neuropathic pain and nerve injury to injured nerves.
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24
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Characterization of the peripheral artery disease symptom experience. Geriatr Nurs 2015; 36:293-300. [PMID: 25935355 DOI: 10.1016/j.gerinurse.2015.03.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Accepted: 03/27/2015] [Indexed: 11/23/2022]
Abstract
Claudication is the most commonly recognized peripheral artery disease (PAD) symptom, but not the most prevalent. Only 7.5%-33% of patients report claudication as being part of their symptom experience. However, there is little evidence supporting atypical symptom reporting. The study purpose was to describe the full spectrum of symptoms experienced by older and younger individuals with PAD. Semistructured interviews were conducted with a purposive sample of 38 community-dwelling adults aged 49-83 years; transcripts were analyzed using content analysis. Six themes emerged: symptom descriptors (claudication and atypical), maintaining equilibrium, temporal fluctuations, the role of exercise, perceived impact on quality of life, and disease presence and treatment. Results suggest heavy reliance on claudication can result in mis- or under-diagnosis of PAD. Further research is needed to validate the correspondence of atypical symptoms with ischemic changes during exercise to broaden currently accepted symptom locations and descriptors associated with PAD.
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Mahe G, Kalra M, Abraham P, Liedl DA, Wennberg PW. Application of exercise transcutaneous oxygen pressure measurements for detection of proximal lower extremity arterial disease: a case report. Vasc Med 2015; 20:251-5. [PMID: 25750011 DOI: 10.1177/1358863x14567030] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Proximal claudication is secondary to ischemia caused by peripheral artery disease (PAD), whereas proximal pseudo-claudication is secondary to other disease processes such as hip arthritis, spinal stenosis, neuropathy, and so forth. The differentiation between the two can be challenging. Exercise transcutaneous oxygen pressure measurement (exercise-TcPO2) allows noninvasive detection of flow-reducing lesions in the proximal arteries and tributaries of the lower extremity arterial tree. We present the first case report in the United States using an exercise-TcPO2 algorithm. A 71-year-old diabetic patient with proximal left-sided and right-calf claudication with indeterminate ankle-brachial indices underwent an exercise-TcPO2 study before and after endovascular intervention. Four TcPO2 probes were placed: one at chest level (reference probe), one on each buttock, and one on the symptomatic calf. The Delta from Resting Oxygen Pressure (DROP) index was calculated at each probe site using a previously validated protocol. Proximal left- and right-calf ischemia were confirmed by the initial exercise-TcPO2, and, after endovascular treatment of the left iliac artery lesion, improvements in proximal exercise-TcPO2 values were found. These data suggest that exercise-TcPO2 can be useful in PAD evaluation in patients with non-compressible arteries and/or proximal claudication.
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Affiliation(s)
- Guillaume Mahe
- Gonda Vascular Center, Mayo Clinic, Rochester, MN, USA INSERM Clinical Investigation Center CIC 1414, Rennes, France
| | - Manju Kalra
- Division of Vascular and Endovascular Surgery, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Pierre Abraham
- Laboratory of Vascular Investigations, University Hospital, Angers, France; and Faculty of Medicine, LUNAM University, Angers, France
| | - David A Liedl
- Gonda Vascular Center, Mayo Clinic, Rochester, MN, USA
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Lang PM. [Painful ischemic neuropathy]. DER NERVENARZT 2015; 86:151-155. [PMID: 25620734 DOI: 10.1007/s00115-014-4125-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Chronic ischemia in patients with peripheral arterial disease (PAD) represents a common medical problem. Neuropathic changes and pain caused by chronic ischemia are often found in the lower extremities of these patients. Pain in patients with chronic critical limb ischemia fulfill the criteria of neuropathic pain. Diagnostic tools besides medical history and examination are questionnaires, quantitative sensory testing (QST) and measuring intraepidermal nerve fiber density (IENFD) when indicated. A pharmacological approach with non-opioids and opioids as well as antidepressive and anticonvulsive drugs (according to the recommendations for the therapy of neuropathic pain) seems to be indicated for treating painful ischemic neuropathy. Spinal cord stimulation (SCS) provides the best evidence for invasive procedures in treating chronic ischemic pain.
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Affiliation(s)
- P M Lang
- Klinik für Anaesthesiologie, Klinikum der Universität München, LMU Campus Großhadern, Marchioninistr. 15, 81377, München, Deutschland,
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Boesmueller S, Fialka C, Pretterklieber ML. The arterial supply of the tendon of the long head of the biceps brachii in the human: A combined anatomical and radiological study. Ann Anat 2014; 196:449-55. [DOI: 10.1016/j.aanat.2014.08.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Revised: 08/12/2014] [Accepted: 08/18/2014] [Indexed: 12/29/2022]
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Evaluation of the perception of chronic ischemic pain in humans with peripheral arterial disease. JOURNAL OF VASCULAR NURSING 2014; 32:82-7. [PMID: 25131754 DOI: 10.1016/j.jvn.2014.02.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Revised: 11/13/2013] [Accepted: 02/04/2014] [Indexed: 11/20/2022]
Abstract
The perception of pain is multidimensional, subjective, and unique to each individual and can be influenced by several dimensions of pain. The objective of this study was to evaluate the perception of chronic ischemic pain using the descriptors of pain and to rate the main descriptors of chronic pain to people with peripheral arterial disease (PAD). The study was conducted in two hospitals in Brazil and consisted of two phases. In phase I, 100 participants with a diagnosis of PAD and chronic pain evaluated 50 descriptors of pain using the Multidimensional Pain Evaluation Scale by the psychophysical method of category estimation using a numerical scale with 11 points. In phase II, 30 participants judged the 10 first descriptors selected in phase I by the psychophysical method of magnitude estimation. The average intensity of chronic ischemic pain was 5.59 ± 3.16. The descriptors of chronic pain with higher scores obtained by the method of category estimation were unpleasant, followed by disturbing, strong, concern, tiring, boring, terrible, painful, sickening, and uncomfortable. By the method of magnitude estimation, the descriptors of pain showing sensitive, affective, and cognitive dimensions were identified by the descriptors terrible, follow by painful, uncomfortable, concern, tiring, sickening, strong, disturbing, boring, and unpleasant. This study showed that the chronic ischemic pain by PAD is associated with multidimensional components of pain.
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Reduced intraepidermal nerve fiber density in patients with chronic ischemic pain in peripheral arterial disease. Pain 2014; 155:1784-1792. [PMID: 24931568 DOI: 10.1016/j.pain.2014.06.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2013] [Revised: 06/04/2014] [Accepted: 06/06/2014] [Indexed: 11/22/2022]
Abstract
Chronic ischemic pain in peripheral arterial disease (PAD) is a leading cause of pain in the lower extremities. A neuropathic component of chronic ischemic pain has been shown independent of coexisting diabetes. We aimed to identify a morphological correlate potentially associated with pain and sensory deficits in PAD. Forty patients with symptomatic PAD (Fontaine stages II-IV), 20 with intermittent claudication (CI), and 20 with critical limb ischemia (CLI) were enrolled; 12 volunteers served as healthy controls. All patients were examined using pain scales and questionnaires. All study participants underwent quantitative sensory testing (QST) at the distal calf and skin punch biopsy at the distal leg for determination of intraepidermal nerve fiber density (IENFD). Additionally, S100 beta serum levels were measured as a potential marker for ischemic nerve damage. Neuropathic pain questionnaires revealed slightly higher scores and more pronounced pain-induced disability in CLI patients compared to CI patients. QST showed elevated thermal and mechanical detection pain thresholds as well as dynamic mechanical allodynia, particularly in patients with advanced disease. IENFD was reduced in PAD compared to controls (P<0.05), more pronounced in the CLI subgroup (CLI: 1.3 ± 0.5 fibers/mm, CI: 2.9 ± 0.5 fibers/mm, controls: 5.3 ± 0.6 fibers/mm). In particular, increased mechanical and heat pain thresholds negatively correlated with lower IENFD. Mean S100 beta levels were in the normal range but were higher in advanced disease. Patients with chronic ischemic pain had a reduced IENFD associated with impaired sensory functions. These findings support the concept of a neuropathic component in ischemic pain.
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Schorr EN, Treat-Jacobson D. Methods of symptom evaluation and their impact on peripheral artery disease (PAD) symptom prevalence: a review. Vasc Med 2013; 18:95-111. [PMID: 23509087 DOI: 10.1177/1358863x13480001] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Peripheral artery disease (PAD) is a common progressive atherosclerotic occlusive disease that causes insufficient blood flow to the lower extremities. The symptom that health care professionals most often associate with PAD is claudication. However, patient reporting of claudication is highly variable. A structured literature review was conducted to evaluate how PAD symptoms are identified, defined, and categorized. This review focuses on the development and performance characteristics of PAD symptom questionnaires and the identification of a spectrum of leg symptoms beyond classic claudication. Additionally, potential confounders of PAD symptom reporting and strategies for a more comprehensive assessment of PAD symptoms are discussed. Overall, there is a lack of consistency in the utilization of PAD claudication questionnaires which impacts PAD symptom reporting and categorization. Based on this review, atypical symptoms are commonly reported, but poorly understood. Additional research is needed to gain a better understanding of the presentation of atypical symptoms, as well as the role of age, gender, race, and comorbid conditions on the symptom experience of patients with PAD.
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Affiliation(s)
- Erica N Schorr
- University of Minnesota School of Nursing, Minneapolis, MN 55455, USA.
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Propionyl-L-Carnitine Improves Endothelial Function, Microcirculation and Pain Management in Critical Limb Ischemia. Cardiovasc Drugs Ther 2012; 26:401-8. [DOI: 10.1007/s10557-012-6408-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Ruiz-Salmeron R, De La Cuesta-Diaz A, Constantino-Bermejo M, Pérez-Camacho I, Marcos-Sánchez F, Hmadcha A, Soria B. Angiographic Demonstration of Neoangiogenesis after Intra-arterial Infusion of Autologous Bone Marrow Mononuclear Cells in Diabetic Patients with Critical Limb Ischemia. Cell Transplant 2011; 20:1629-39. [DOI: 10.3727/096368910x0177] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Critical limb ischemia in diabetic patients is associated with high rates of morbidity and mortality. Suboptimal responses to the available medical and surgical treatments are common in these patients, who also demonstrate limited vascular homeostasis. Neovasculogenesis induced by stem cell therapy could be a useful approach for these patients. Neovasculogenesis and clinical improvement were compared at baseline and at 3 and 12 months after autologous bone marrow-derived mononuclear cell (BMMNC) transplantation in diabetic patients with peripheral artery disease. We conducted a prospective study to evaluate the safety and efficacy of intra-arterial administration of autologous BMMNCs (100–400 × 106 cells) in 20 diabetic patients with severe below-the-knee arterial ischemia. Although the time course of clinical effects differed among patients, after 12 months of follow-up all patients presented a notable improvement in the Rutherford-Becker classification, the University of Texas diabetic wound scales, and the Ankle-Brachial Index in the target limb. The clinical outcome was consistent with neovasculogenesis, which was assessed at 3 months by digital subtraction angiography and quantified by MetaMorph software. Unfortunately, local cell therapy in the target limb had no beneficial effect on the high mortality rate in these patients. In diabetic patients with critical limb ischemia, intra-arterial perfusion of BMMNCs is a safe procedure that generates a significant increase in the vascular network in ischemic areas and promotes remarkable clinical improvement.
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Affiliation(s)
| | | | | | | | | | - Abdelkrim Hmadcha
- Centro Andaluz de Biología Molecular y Medicina Regenerativa (CABIMER), Sevilla, Spain
- CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Barcelona, Spain
| | - Bernat Soria
- Centro Andaluz de Biología Molecular y Medicina Regenerativa (CABIMER), Sevilla, Spain
- CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Barcelona, Spain
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Sprengers RW, Teraa M, Moll FL, de Wit GA, van der Graaf Y, Verhaar MC. Quality of life in patients with no-option critical limb ischemia underlines the need for new effective treatment. J Vasc Surg 2010; 52:843-9, 849.e1. [PMID: 20598482 DOI: 10.1016/j.jvs.2010.04.057] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2010] [Revised: 04/19/2010] [Accepted: 04/20/2010] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To provide a solid baseline reference for quality of life (QoL) in patients with no-option critical limb ischemia (CLI). CLI is associated with surgery, endovascular interventions, hospitalization, and a poor prognosis. An increasing number of clinical trials are, therefore, investigating new treatment strategies (eg, therapeutic neovascularization) in patients with CLI. QoL serves as an important secondary endpoint in many of these trials, but solid reference QoL data for patients with no-option CLI are lacking. METHODS The Medical Outcomes Study Short Form 36 (SF-36) and the EuroQol-5D (EQ-5D) questionnaires were used to obtain baseline QoL scores from 47 patients with no-option CLI participating in a therapeutic neovascularization trial. To allow for easy comparability, a norm-based scoring (NBS) method was used to report the results of the SF-36. Scores of patients with CLI were furthermore compared with scores of patients with milder forms of peripheral arterial disease (PAD) and with patients with cardiovascular risk factors only. Determinants of QoL in patients with PAD were identified using multiple linear regression methods. RESULTS Patients with no-option CLI reported QoL scores below the general population mean on every health dimension of the SF-36. Physical functioning, role physical functioning, and bodily pain were affected most intensively. These poor physical QoL scores were further underlined when compared with other patients with milder forms of PAD or patients with cardiovascular risk factors only. Patients with CLI scored poorly on the pain/discomfort and the usual activities domain of the EQ-5D. Diabetes, female gender, body mass index, and the ankle-brachial index at rest were significant determinants of the QoL in PAD on multivariate analysis. CONCLUSION The QoL data of patients with no-option CLI using NBS methods for the SF-36 provide a baseline reference for ongoing clinical trials on new treatment strategies. Our data stress the need for new revascularization therapies in patients with no-option CLI.
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Affiliation(s)
- Ralf W Sprengers
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
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Zankl AR, Ivandic B, Andrassy M, Volz HC, Krumsdorf U, Blessing E, Katus HA, Tiefenbacher CP. Telmisartan improves absolute walking distance and endothelial function in patients with peripheral artery disease. Clin Res Cardiol 2010; 99:787-94. [DOI: 10.1007/s00392-010-0184-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2009] [Accepted: 06/17/2010] [Indexed: 11/27/2022]
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Zusammenhang von Quantitativer Sensorischer Testung und Fragebögen zu neuropathischen Schmerzen am Beispiel chronischer Ischämieschmerzen bei PAVK. Schmerz 2009; 23:251-4, 256-8. [DOI: 10.1007/s00482-009-0773-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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36
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Lang PM, Vock G, Schober GM, Kramer S, Abahji T, Crispin A, Irnich D, Hoffmann U. Impact of endovascular intervention on pain and sensory thresholds in nondiabetic patients with intermittent claudication: a pilot study. THE JOURNAL OF PAIN 2008; 10:264-73. [PMID: 19010739 DOI: 10.1016/j.jpain.2008.09.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2008] [Revised: 08/11/2008] [Accepted: 09/08/2008] [Indexed: 12/14/2022]
Abstract
UNLABELLED Pain and sensory neuropathy are common in patients with peripheral arterial disease. So far it is unknown to what extent pain and sensory parameters can be ameliorated by endovascular intervention used to resolve the arterial obstruction. Seventeen nondiabetic patients with intermittent claudication were investigated in the present study. The patients had to undergo percutaneous transluminal angioplasty (PTA) to improve blood flow in the affected leg. To acquire detailed information of their sensory state quantitative sensory testing (QST) was performed before and 24 hours and 3 months after PTA. QST is a standardized clinical testing procedure for the detection of sensory changes that consists of multiple tests for thermal and mechanical detection and pain thresholds as well as vibratory thresholds and stimulus response functions. An age-matched control group was investigated with an interval of 3 months. Pain during exercise decreased by 60% (examined by numerical rating scale) after endovascular intervention, whereas the ankle/brachial-index-representing the peripheral hemodynamic situation-increased by 29%. Sensory function determined by QST did not change significantly following PTA over a 3-month period. Successfully performed PTA is highly effective in reducing exercise induced pain in patients with intermittent claudication. PERSPECTIVE The study demonstrates that successfully performed PTA is a highly effective tool in reducing exercise induced pain in patients with intermittent claudication. However, the pain reduction observed cannot be verified by evaluating sensory functions using standardized quantitative sensory testing.
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Affiliation(s)
- Philip M Lang
- Department of Anesthesiology, Interdisciplinary Pain Center, University of Munich, Germany.
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