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Buoite Stella A, Rupel K, Tamos M, Fratter G, Deodato M, Martini M, Biasotto M, Di Lenarda R, Ottaviani G. Effect of repeated topical capsaicin gel administration on oral thermal quantitative sensory testing: A two-arm longitudinal study. Oral Dis 2024. [PMID: 38808363 DOI: 10.1111/odi.15012] [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: 03/06/2024] [Revised: 05/03/2024] [Accepted: 05/14/2024] [Indexed: 05/30/2024]
Abstract
OBJECTIVES Few studies used thermal quantitative sensory testing to assess the effects of repeated capsaicin gel administration in the oral cavity. This study aimed to investigate thermal sensory and pain thresholds before and after repeated capsaicin gel administration. SUBJECTS AND METHODS Ten healthy females (22 ± 2 years) applied a capsaicin gel on the gingival mucosa twice daily for 14 days, and heat pain threshold, warm detection threshold, cold pain threshold, and cold detection threshold were assessed on the oral mucosa. Measurements were performed before and after the 14 days and were compared to a control sample (n = 10, all females, 23 ± 3 years). RESULTS Capsaicin increased heat pain threshold in the anterior maxilla by 2.9°C (95% CI: 1.6-4.2) (p < 0.001) and in the anterior mandible by 2.2°C (95% CI: 1.0-3.4) (p = 0.001), similar to warm detection threshold that increased by Δ1.1°C (95% CI: 0.3-1.9) (p = 0.009). No significant changes were found in the controls. CONCLUSIONS These findings encourage the use of thermal quantitative sensory testing in the oral cavity to assess thermal sensation, which might be useful for assessing the effects of therapies aimed at reducing pain.
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Affiliation(s)
- Alex Buoite Stella
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Katia Rupel
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Martina Tamos
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Giampaolo Fratter
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Manuela Deodato
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Miriam Martini
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Matteo Biasotto
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Roberto Di Lenarda
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Giulia Ottaviani
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
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2
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Slow depolarizing stimuli differentially activate mechanosensitive and silent C nociceptors in human and pig skin. Pain 2020; 161:2119-2128. [DOI: 10.1097/j.pain.0000000000001912] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Accepted: 04/08/2020] [Indexed: 01/10/2023]
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3
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Uhelski ML, McAdams B, Johns ME, Kabadi RA, Simone DA, Banik RK. Lack of relationship between epidermal denervation by capsaicin and incisional pain behaviours: A laser scanning confocal microscopy study in rats. Eur J Pain 2020; 24:1197-1208. [DOI: 10.1002/ejp.1564] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 03/16/2020] [Accepted: 03/19/2020] [Indexed: 12/21/2022]
Affiliation(s)
- Megan L. Uhelski
- Department of Diagnostic and Biological Sciences School of Dentistry University of Minnesota Minneapolis MN USA
| | - Brian McAdams
- Department of Diagnostic and Biological Sciences School of Dentistry University of Minnesota Minneapolis MN USA
| | - Malcolm E. Johns
- Department of Anesthesiology School of Medicine University of Minnesota Minneapolis MN USA
| | - Rajiv A. Kabadi
- NJ Neuroscience Institute and Seton Hall UniversitySchool of Graduate Medical EducationJFK Medical Center Edison NJ USA
| | - Donald A. Simone
- Department of Diagnostic and Biological Sciences School of Dentistry University of Minnesota Minneapolis MN USA
| | - Ratan K. Banik
- Department of Anesthesiology School of Medicine University of Minnesota Minneapolis MN USA
- NJ Neuroscience Institute and Seton Hall UniversitySchool of Graduate Medical EducationJFK Medical Center Edison NJ USA
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4
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Capsaicin 8% patch reversibly reduces A-delta fiber evoked potential amplitudes. Pain Rep 2018; 3:e644. [PMID: 29756090 PMCID: PMC5902250 DOI: 10.1097/pr9.0000000000000644] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2017] [Revised: 01/07/2018] [Accepted: 01/31/2018] [Indexed: 01/30/2023] Open
Abstract
The capsaicin 8% patch is a treatment option in patients with localized peripheral neuropathic pain. We provide first data on the effect of capsaicin on the electrophysiological properties of A-delta fibers. Introduction: The capsaicin 8% patch is a treatment option in patients with localized peripheral neuropathic pain. Better understanding of its mechanisms of action and knowledge on predictive biomarkers for a treatment response is warranted. Objectives: To use electrically evoked pain-related potentials for investigation of A-delta fiber conduction after capsaicin 8% patch treatment. Methods: We studied 11 healthy controls at the dorsal hand and the foot and 12 patients with neuropathic pain at the area affected by neuropathic pain before and 2 hours after application of a capsaicin 8% patch (Qutenza). Patients were additionally phenotyped using quantitative sensory testing and skin biopsy. Results: Peak-to-peak N1-P1 amplitudes (PPA) were reduced after Qutenza application by a median of 60% in 6/11 controls and by 33% in patients with neuropathic pain compared with baseline; they were increased in 3 controls that did not develop capsaicin-induced pain. Patients with elevated cold detection thresholds more often had reduced PPA after Qutenza than those with normal cold detection threshold. Patients with reduced PPA after capsaicin application and with capsaicin-induced pain were more likely to achieve pain reduction on Qutenza. Conclusion: The capsaicin 8% patch induces a reduction in A-delta PPA in healthy persons and in patients with neuropathic pain adding to the mechanistic understanding of its effect.
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5
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Chiang H, Chang KC, Kan HW, Wu SW, Tseng MT, Hsueh HW, Lin YH, Chao CC, Hsieh ST. Physiological and pathological characterization of capsaicin-induced reversible nerve degeneration and hyperalgesia. Eur J Pain 2018; 22:1043-1056. [DOI: 10.1002/ejp.1189] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/28/2017] [Indexed: 11/07/2022]
Affiliation(s)
- H. Chiang
- Department of Anatomy and Cell Biology; National Taiwan University College of Medicine; Taipei Taiwan
| | - K.-C. Chang
- Department of Neurology; National Taiwan University Hospital; Taipei Taiwan
| | - H.-W. Kan
- Department of Anatomy and Cell Biology; National Taiwan University College of Medicine; Taipei Taiwan
| | - S.-W. Wu
- Department of Anatomy and Cell Biology; National Taiwan University College of Medicine; Taipei Taiwan
- Department of Neurology; National Taiwan University Hospital; Taipei Taiwan
| | - M.-T. Tseng
- Graduate Institute of Brain and Mind Sciences; National Taiwan University College of Medicine; Taipei Taiwan
| | - H.-W. Hsueh
- Department of Neurology; National Taiwan University Hospital; Taipei Taiwan
| | - Y.-H. Lin
- Department of Neurology; National Taiwan University Hospital; Taipei Taiwan
| | - C.-C. Chao
- Department of Neurology; National Taiwan University Hospital; Taipei Taiwan
| | - S.-T. Hsieh
- Department of Anatomy and Cell Biology; National Taiwan University College of Medicine; Taipei Taiwan
- Department of Neurology; National Taiwan University Hospital; Taipei Taiwan
- Graduate Institute of Brain and Mind Sciences; National Taiwan University College of Medicine; Taipei Taiwan
- Graduate Institute of Clinical Medicine; National Taiwan University College of Medicine; Taipei Taiwan
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6
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Garibyan L, Cornelissen L, Sipprell W, Pruessner J, Elmariah S, Luo T, Lerner EA, Jung Y, Evans C, Zurakowski D, Berde CB, Rox Anderson R. Transient Alterations of Cutaneous Sensory Nerve Function by Noninvasive Cryolipolysis. J Invest Dermatol 2015; 135:2623-2631. [PMID: 26099028 PMCID: PMC4640987 DOI: 10.1038/jid.2015.233] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2015] [Revised: 05/09/2015] [Accepted: 06/09/2015] [Indexed: 12/27/2022]
Abstract
Cryolipolysis is a noninvasive, skin cooling treatment for local fat reduction that causes prolonged hypoesthesia over the treated area. We tested the hypothesis that cryolipolysis can attenuate nociception of a range of sensory stimuli, including stimuli that evoke itch. The effects of cryolipolysis on sensory phenomena were evaluated by quantitative sensory testing (QST) in 11 healthy subjects over a period of 56 days. Mechanical and thermal pain thresholds were measured on treated and contralateral untreated (control) flanks. Itch duration was evaluated following histamine iontophoresis. Unmyelinated epidermal nerve fiber and myelinated dermal nerve fiber densities were quantified in skin biopsies from six subjects. Cryolipolysis produced a marked decrease in mechanical and thermal pain sensitivity. Hyposensitivity started between two to seven days after cryolipolysis and persisted for at least thirty-five days post treatment. Skin biopsies revealed that cryolipolysis decreased epidermal nerve fiber density, as well as dermal myelinated nerve fiber density, which persisted throughout the study. In conclusion, cryolipolysis causes significant and prolonged decreases in cutaneous sensitivity. Our data suggest that controlled skin cooling to specifically target cutaneous nerve fibers has the potential to be useful for prolonged relief of cutaneous pain and might have a use as a research tool to isolate and study cutaneous itch-sensing nerves in human skin.
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Affiliation(s)
- Lilit Garibyan
- Wellman Center for Photomedicine, Massachusetts General Hospital; Department of Dermatology, Harvard Medical School, Boston, USA.
| | - Laura Cornelissen
- Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital; Department of Anesthesia, Harvard Medical School, Boston, USA
| | - William Sipprell
- Wellman Center for Photomedicine, Massachusetts General Hospital; Department of Dermatology, Harvard Medical School, Boston, USA
| | - Joachim Pruessner
- Wellman Center for Photomedicine, Massachusetts General Hospital; Department of Dermatology, Harvard Medical School, Boston, USA
| | - Sarina Elmariah
- Cutaneous Biology Research Center, Massachusetts General Hospital; Department of Dermatology, Harvard Medical School, Boston, USA
| | - Tuan Luo
- Cutaneous Biology Research Center, Massachusetts General Hospital; Department of Dermatology, Harvard Medical School, Boston, USA
| | - Ethan A Lerner
- Cutaneous Biology Research Center, Massachusetts General Hospital; Department of Dermatology, Harvard Medical School, Boston, USA
| | - Yookyung Jung
- Wellman Center for Photomedicine, Massachusetts General Hospital; Department of Dermatology, Harvard Medical School, Boston, USA
| | - Conor Evans
- Wellman Center for Photomedicine, Massachusetts General Hospital; Department of Dermatology, Harvard Medical School, Boston, USA
| | - David Zurakowski
- Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital; Department of Anesthesia, Harvard Medical School, Boston, USA
| | - Charles B Berde
- Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital; Department of Anesthesia, Harvard Medical School, Boston, USA
| | - R Rox Anderson
- Wellman Center for Photomedicine, Massachusetts General Hospital; Department of Dermatology, Harvard Medical School, Boston, USA
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7
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Ma XL, Zhang FX, Dong F, Bao L, Zhang X. Experimental evidence for alleviating nociceptive hypersensitivity by single application of capsaicin. Mol Pain 2015; 11:22. [PMID: 25896608 PMCID: PMC4422461 DOI: 10.1186/s12990-015-0019-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Accepted: 04/10/2015] [Indexed: 02/08/2023] Open
Abstract
The single application of high-concentration of capsaicin has been used as an analgesic therapy of persistent pain. However, its effectiveness and underlying mechanisms remain to be further evaluated with experimental approaches. The present study provided evidence showing that the single application of capsaicin dose-dependently alleviated nociceptive hypersensitivity, and reduced the action potential firing in small-diameter neurons of the dorsal root ganglia (DRG) in rats and mice. Pre-treatment with capsaicin reduced formalin-induced acute nocifensive behavior after a brief hyperalgesia in rats and mice. The inhibitory effects of capsaicin were calcium-dependent, and mediated by the capsaicin receptor (transient receptor potential vanilloid type-1). We further found that capsaicin exerted inhibitory effects on the persistent nociceptive hypersensitivity induced by peripheral inflammation and nerve injury. Thus, these results support the long-lasting and inhibitory effects of topical capsaicin on persistent pain, and the clinic use of capsaicin as a pain therapy.
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Affiliation(s)
- Xiao-Li Ma
- Institute of Neuroscience and State Key Laboratory of Neuroscience, CAS Center for Excellence in Brain Science, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, 320 Yue Yang Road, Shanghai, 200031, China.
| | - Fang-Xiong Zhang
- Institute of Neuroscience and State Key Laboratory of Neuroscience, CAS Center for Excellence in Brain Science, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, 320 Yue Yang Road, Shanghai, 200031, China.
| | - Fei Dong
- Institute of Neuroscience and State Key Laboratory of Neuroscience, CAS Center for Excellence in Brain Science, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, 320 Yue Yang Road, Shanghai, 200031, China.
| | - Lan Bao
- State Key Laboratory of Cell Biology, Institute of Biochemistry and Cell Biology, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, Shanghai, 200031, China. .,School of Life Science and Technology, ShanghaiTech University, Shanghai, 201210, China.
| | - Xu Zhang
- Institute of Neuroscience and State Key Laboratory of Neuroscience, CAS Center for Excellence in Brain Science, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, 320 Yue Yang Road, Shanghai, 200031, China. .,School of Life Science and Technology, ShanghaiTech University, Shanghai, 201210, China.
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8
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Guindon J, Lin JS. Inflammatory pain models with capsaicin or glutamate injections: Are they comparable and reproducible? Clin Exp Pharmacol Physiol 2014; 41:947-9. [DOI: 10.1111/1440-1681.12306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Josée Guindon
- Department of Pharmacology and Neuroscience; Texas Tech University Health Sciences Center; Lubbock TX USA
| | - Jian-Sheng Lin
- Integrative Physiology of the Brain Arousal Systems; Lyon Neuroscience Research Center; INSERM U1028-CNRS UMR5292; Claude Bernard University; Lyon France
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9
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Sensory correlates of pain in peripheral neuropathies. Clin Neurophysiol 2014; 125:1048-58. [DOI: 10.1016/j.clinph.2013.09.038] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2013] [Revised: 08/26/2013] [Accepted: 09/30/2013] [Indexed: 01/04/2023]
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10
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Caty G, Hu L, Legrain V, Plaghki L, Mouraux A. Psychophysical and electrophysiological evidence for nociceptive dysfunction in complex regional pain syndrome. Pain 2013; 154:2521-2528. [DOI: 10.1016/j.pain.2013.07.038] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Revised: 07/19/2013] [Accepted: 07/22/2013] [Indexed: 12/27/2022]
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11
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Knolle E, Zadrazil M, Kovacs GG, Medwed S, Scharbert G, Schemper M. Comparison of cooling and EMLA to reduce the burning pain during capsaicin 8% patch application: a randomized, double-blind, placebo-controlled study. Pain 2013; 154:2729-2736. [PMID: 23933232 DOI: 10.1016/j.pain.2013.08.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2013] [Revised: 07/22/2013] [Accepted: 08/02/2013] [Indexed: 11/28/2022]
Abstract
Topical capsaicin 8% was developed for the treatment of peripheral neuropathic pain. The pain reduction is associated with a reversible reduction of epidermal nerve fiber density (ENFD). During its application, topical capsaicin 8% provokes distinct pain. In a randomized, double-blind study analyzed with a block factorial analysis of variance, we tested whether cooling the skin would result in reliable prevention of the application pain without inhibiting reduction of ENFD. A capsaicin 8% patch was cut into 4 quarters and 2 each were applied for 1 hour on the anterior thighs of 12 healthy volunteers. A randomization scheme provided for 1 of the application sites of each thigh to be pretreated with EMLA and the other with placebo, whereas both application sites of 1 thigh, also randomly selected, were cooled by cool packs, resulting in a site temperature of 20°C during the entire treatment period. The maximum pain level given for the cooled sites (visual analogue scale [VAS] 1.3 ± 1.4) proved to be significantly lower than for the non-cooled sites (VAS 7.5 ± 1.9) (P < .0001). In contrast, there was no significant difference in application pain between the sites pretreated with EMLA or with placebo (VAS 4.1 ± 3.6 vs 4.8 ± 3.5, P = .1084). At all application sites, ENFD was significantly reduced by 8.0 ± 2.8 (ENF/mm ± SD, P < .0001), that is, 70%, with no significant differences between the sites with the different experimental conditions. In conclusion, cooling the skin to 20°C reliably prevents the pain from capsaicin 8% patch application, whereas EMLA does not. ENFD reduction is not inhibited by cooling.
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Affiliation(s)
- Erich Knolle
- Department of Anaesthesia, General Intensive Care and Pain Management, Medical University of Vienna, Vienna, Austria Institute of Neurology, Medical University of Vienna, Vienna, Austria Section for Clinical Biometrics, Medical University of Vienna, Vienna, Austria
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12
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Zotova EG, Arezzo JC. NON-INVASIVE EVALUATION OF NERVE CONDUCTION IN SMALL DIAMETER FIBERS IN THE RAT. PHYSIOLOGY JOURNAL 2013; 2013:254789. [PMID: 23580940 PMCID: PMC3620683 DOI: 10.1155/2013/254789] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
A novel non-invasive technique was applied to measure velocity within slow conducting axons in the distal extreme of the sciatic nerve (i.e., digital nerve) in a rat model. The technique is based on the extraction of rectified multiple unit activity (MUA) from in vivo whole nerve compound responses. This method reliably identifies compound action potentials in thinly myelinated fibers conducting at a range of 9-18 m/s (Aδ axons), as well as in a subgroup of unmylinated C fibers conducting at approximately 1-2 m/s. The sensitivity of the method to C-fiber conduction was confirmed by the progressive decrement of the responses in the 1-2 m/s range over a 20-day period following the topical application of capsaicin (ANOVA p<0.03). Increasing the frequency of applied repetitive stimulation over a range of 0.75 Hz to 6.0 Hz produced slowing of conduction and a significant decrease in the magnitude of the compound C-fiber response (ANOVA p<0.01). This technique offers a unique opportunity for the non-invasive, repeatable, and quantitative assessment of velocity in the subsets of Aδ and C fibers in parallel with evaluation of fast nerve conduction.
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Affiliation(s)
- Elena G. Zotova
- Department of Neurology, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY, 10461, USA
| | - Joseph C. Arezzo
- Department of Neurology, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY, 10461, USA
- Department of Neuroscience, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY, 10461, USA
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13
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Haanpää M, Treede RD. Capsaicin for neuropathic pain: linking traditional medicine and molecular biology. Eur Neurol 2012; 68:264-75. [PMID: 23037991 DOI: 10.1159/000339944] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2012] [Accepted: 05/29/2012] [Indexed: 12/13/2022]
Abstract
Capsaicin has long been used as a traditional medicine to treat pain and, recently, its mechanism of analgesic action has been discovered. This review article documents the clinical development of capsaicin to demonstrate that pharmacognosy still has a profound influence on modern-day drug development programs. Capsaicin is a highly selective agonist for the transient receptor potential channel vanilloid-receptor type 1 (TRPV1), which is expressed on central and peripheral terminals of nociceptive primary sensory neurons. Knockout studies have revealed the importance of TRPV1 as a molecular pain integrator and target for novel analgesic agents. Topical application of capsaicin at the peripheral terminal of TRPV1-expressing neurons superficially denervates the epidermis in humans in a highly selective manner and results in hypoalgesia. In three recent randomized controlled trials, a patch containing high-concentration capsaicin demonstrated meaningful efficacy and tolerability relative to a low-concentration capsaicin control patch in patients with peripheral neuropathic pain. Data from clinical practice will determine if the high-concentration capsaicin patch is effective in real-world settings.
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Affiliation(s)
- Maija Haanpää
- Department of Neurosurgery, Helsinki University Central Hospital, Töölö Hospital, Helsinki, Finland
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14
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Franz M, Spohn D, Ritter A, Rolke R, Miltner WHR, Weiss T. Laser heat stimulation of tiny skin areas adds valuable information to quantitative sensory testing in postherpetic neuralgia. Pain 2012; 153:1687-1694. [PMID: 22657400 DOI: 10.1016/j.pain.2012.04.029] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2011] [Revised: 04/25/2012] [Accepted: 04/30/2012] [Indexed: 11/26/2022]
Abstract
Patients suffering from postherpetic neuralgia often complain about hypo- or hypersensation in the affected dermatome. The loss of thermal sensitivity has been demonstrated by quantitative sensory testing as being associated with small-fiber (Aδ- and C-fiber) deafferentation. We aimed to compare laser stimulation (radiant heat) to thermode stimulation (contact heat) with regard to their sensitivity and specificity to detect thermal sensory deficits related to small-fiber dysfunction in postherpetic neuralgia. We contrasted detection rate of laser stimuli with 5 thermal parameters (thresholds of cold/warm detection, cold/heat pain, and sensory limen) of quantitative sensory testing. Sixteen patients diagnosed with unilateral postherpetic neuralgia and 16 age- and gender-matched healthy control subjects were tested. Quantitative sensory testing and laser stimulation of tiny skin areas were performed in the neuralgia-affected skin and in the contralateral homologue of the neuralgia-free body side. Across the 5 thermal parameters of thermode stimulation, only one parameter (warm detection threshold) revealed sensory abnormalities (thermal hypoesthesia to warm stimuli) in the neuralgia-affected skin area of patients but not in the contralateral area, as compared to the control group. In contrast, patients perceived significantly less laser stimuli both in the affected skin and in the contralateral skin compared to controls. Overall, laser stimulation proved more sensitive and specific in detecting thermal sensory abnormalities in the neuralgia-affected skin, as well as in the control skin, than any single thermal parameter of thermode stimulation. Thus, laser stimulation of tiny skin areas might be a useful diagnostic tool for small-fiber dysfunction.
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Affiliation(s)
- Marcel Franz
- Department of Biological and Clinical Psychology, Friedrich-Schiller-University of Jena, Jena D-07743, Germany Department of Palliative Care, University of Bonn, Bonn, Germany
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15
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Schestatsky P, Stefani LC, Sanches PR, Silva Júnior DPD, Torres ILS, Dall-Agnol L, Balbinot LF, Caumo W. Validation of a Brazilian quantitative sensory testing (QST) device for the diagnosis of small fiber neuropathies. ARQUIVOS DE NEURO-PSIQUIATRIA 2011; 69:943-8. [DOI: 10.1590/s0004-282x2011000700019] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2011] [Accepted: 07/25/2011] [Indexed: 11/22/2022]
Abstract
Quantitative sensory testing (QST) is defined as the determination of thresholds for sensory perception under controlled stimulus. Our aim was to validate a new QST device for Brazilian sample. In 20 healthy adults, thermoalgesic thresholds were assessed using a QST prototype (Heat Pain Stimulator-1.1.10; Brazil). A 30 × 30 mm² thermode with a 1°C/s stimulus change rate were applied. Thresholds of three consecutive stimuli were averaged in two different sessions separated by at least two weeks. Additionally long thermal heat pain stimulus was performed. To evaluate the consistency of our method we also analyzed 11 patients with small fiber neuropathy. Results showed good reproducibility of thermal perception thresholds in normal individuals and plausible abnormal thresholds in patients. We conclude that our QST device is reliable when analyzing the nociceptive pathway in controls and patients.
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Affiliation(s)
| | | | | | | | | | | | | | - Wolnei Caumo
- Universidade Federal do Rio Grande do Sul, Brazil; UFRGS; UFRGS, Brazil
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16
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Shenoy R, Roberts K, Papadaki A, McRobbie D, Timmers M, Meert T, Anand P. Functional MRI brain imaging studies using the Contact Heat Evoked Potential Stimulator (CHEPS) in a human volunteer topical capsaicin pain model. J Pain Res 2011; 4:365-71. [PMID: 22090805 PMCID: PMC3215516 DOI: 10.2147/jpr.s24810] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Acute application of topical capsaicin produces spontaneous burning and stinging pain similar to that seen in some neuropathic states, with local hyperalgesia. Use of capsaicin applied topically or injected intradermally has been described as a model for neuropathic pain, with patterns of activation in brain regions assessed using functional magnetic resonance imaging (fMRI) and positron emission tomography. The Contact Heat Evoked Potential Stimulator (CHEPS) is a noninvasive clinically practical method of stimulating cutaneous A-delta nociceptors. In this study, topical capsaicin (1%) was applied to the left volar forearm for 15 minutes of twelve adult healthy human volunteers. fMRI scans and a visual analog pain score were recorded during CHEPS stimulation precapsaicin and postcapsaicin application. Following capsaicin application there was a significant increase in visual analog scale (mean ± standard error of the mean; precapsaicin 26.4 ± 5.3; postcapsaicin 48.9 ± 6.0; P < 0.0001). fMRI demonstrated an overall increase in areas of activation, with a significant increase in the contralateral insular signal (mean ± standard error of the mean; precapsaicin 0.434 ± 0.03; postcapsaicin 0.561 ± 0.07; P = 0.047). The authors of this paper recently published a study in which CHEPS-evoked A-delta cerebral potential amplitudes were found to be decreased postcapsaicin application. In patients with neuropathic pain, evoked pain and fMRI brain responses are typically increased, while A-delta evoked potential amplitudes are decreased. The protocol of recording fMRI following CHEPS stimulation after topical application of capsaicin could be combined with recording of evoked potentials to provide a simple, rapid, and robust volunteer model to develop novel drugs for neuropathic pain.
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Affiliation(s)
- Ravikiran Shenoy
- Peripheral Neuropathy Unit, Hammersmith Hospital, Imperial College London
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17
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Asymptomatic small fiber neuropathy in diabetes mellitus: investigations with intraepidermal nerve fiber density, quantitative sensory testing and laser-evoked potentials. J Neurol 2011; 258:1852-64. [PMID: 21472496 DOI: 10.1007/s00415-011-6031-z] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2010] [Revised: 03/15/2011] [Accepted: 03/24/2011] [Indexed: 12/21/2022]
Abstract
This study aimed at evaluating the performance of a battery of morphological and functional tests for the assessment of small nerve fiber loss in asymptomatic diabetic neuropathy (DNP). Patients diagnosed for ≥10 years with type 1 (n = 10) or type 2 (n = 13) diabetes mellitus (DM) without conventional symptoms or signs of DNP were recruited and compared with healthy controls (n = 18) and patients with overt DNP (n = 5). Intraepidermal nerve fiber density (IENFd) was measured with PGP9.5 immunostaining on punch skin biopsies performed at the distal leg. Functional tests consisted of quantitative sensory testing (QST) for light-touch, cool, warm and heat pain detection thresholds and brain-evoked potentials with electrical (SEPs) and CO(2) laser stimulation [laser-evoked potentials (LEPs)] of hand dorsum and distal leg using small (0.8 mm(2)) and large (20 mm(2)) beam sizes. Results confirmed a state of asymptomatic DNP in DM, but only at the distal leg. Defining a critical small fiber loss as a reduction of IENFd ≤-2 z scores of healthy controls, this state prevailed in type 2 (30%) over type 1 DM (10%) patients despite similar disease duration and current glycemic control. LEPs with the small laser beam performed best in terms of sensitivity (91%), specificity (83%) and area-under-the ROC curve (0.924). Although this performance was not statically different from that of warm and cold detection threshold, LEPs offer an advantage over QST given that they bypass the subjective report and are therefore unbiased by perceptual factors.
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Pieper K, Schuster T, Levionnois O, Matis U, Bergadano A. Antinociceptive efficacy and plasma concentrations of transdermal buprenorphine in dogs. Vet J 2011; 187:335-41. [DOI: 10.1016/j.tvjl.2010.01.013] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2009] [Revised: 01/12/2010] [Accepted: 01/21/2010] [Indexed: 10/19/2022]
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Variation in quantitative sensory testing and epidermal nerve fiber density in repeated measurements. Pain 2010; 151:575-581. [PMID: 20851518 DOI: 10.1016/j.pain.2010.06.034] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2009] [Revised: 04/29/2010] [Accepted: 06/24/2010] [Indexed: 12/14/2022]
Abstract
Quantitative sensory testing (QST) is commonly used to evaluate peripheral sensory function in neuropathic conditions. QST measures vary in repeated measurements of normal subjects but it is not known whether QST can reflect small changes in epidermal nerve fiber density (ENFd). This study evaluated QST measures (touch, mechanical pain, heat pain and innocuous cold sensations) for differences between genders and over time using ENFd as an objective-independent measure. QST was performed on the thighs of 36 healthy volunteers on four occasions between December and May. ENFd in skin biopsies was determined on three of those visits. Compared to men, women had a higher ENFd, a difference of 12.2 ENFs/mm. They also had lower tactile and innocuous cold thresholds, and detected mechanical pain (pinprick) at a higher frequency. Heat pain thresholds did not differ between genders. By the end of the 24-week study, men and women showed a small reduction (p<0.05) in the frequency of sharp mechanical pain evoked by pinprick whereas tactile and thermal thresholds showed no change. This coincided with a small decrease in ENFd, 4.18 ENFs/mm. Variation in measurements over time was large in a fraction of normal subjects. We conclude that most QST measures detect relatively large differences in epidermal innervation (12.2 ENFs/mm), but response to mechanical pain was the only sensory modality tested with the sensitivity to detect small changes in innervation (4.18 ENFs/mm). Since some individuals had large unsystematic variations, unexpected test results should therefore alert clinicians to test additional locations.
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Mouraux A, Iannetti GD, Plaghki L. Low intensity intra-epidermal electrical stimulation can activate Aδ-nociceptors selectively. Pain 2010; 150:199-207. [DOI: 10.1016/j.pain.2010.04.026] [Citation(s) in RCA: 157] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2009] [Revised: 04/21/2010] [Accepted: 04/21/2010] [Indexed: 11/24/2022]
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A Randomized, Controlled, Open-Label Study of the Long-Term Effects of NGX-4010, a High-Concentration Capsaicin Patch, on Epidermal Nerve Fiber Density and Sensory Function in Healthy Volunteers. THE JOURNAL OF PAIN 2010; 11:579-87. [DOI: 10.1016/j.jpain.2009.09.019] [Citation(s) in RCA: 141] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2009] [Revised: 09/11/2009] [Accepted: 09/29/2009] [Indexed: 11/23/2022]
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Ragé M, Van Acker N, Facer P, Shenoy R, Knaapen MWM, Timmers M, Streffer J, Anand P, Meert T, Plaghki L. The time course of CO2 laser-evoked responses and of skin nerve fibre markers after topical capsaicin in human volunteers. Clin Neurophysiol 2010; 121:1256-66. [PMID: 20347388 DOI: 10.1016/j.clinph.2010.02.159] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2009] [Revised: 01/28/2010] [Accepted: 02/28/2010] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To assess the temporal relationship between skin nerve denervation and regeneration (dermal and intra-epidermal fibres, IENF) and functional changes (CO(2) laser-evoked potentials, LEPs, and quantitative sensory tests, QST) after topical cutaneous application of capsaicin. METHODS Capsaicin (0.075%) was applied to the lateral calf for three consecutive days. QST, LEPs and skin biopsies were performed at baseline and time intervals up to 54days post-capsaicin treatment. Biopsies were immunostained with antibodies for PGP9.5, TRPV1, and GAP-43 (marker of regenerating nerve fibres), and analyzed for IENFs and dermal innervation (for GAP-43). RESULTS At 1day post-capsaicin, cutaneous thermal sensitivity was reduced, as were LEPs. PGP9.5, TRPV1, and GAP-43 immunoreactive-nerve fibres were almost completely absent. By Day 12, LEPs had fully recovered, but PGP9.5 and TRPV1 IENF continued to be significantly decreased 54days post-capsaicin. In contrast, dermal GAP-43 immunoreactivity closely matched recovery of LEPs. CONCLUSIONS A good correlation was observed between LEPs and GAP-43 staining, in contrast to PGP9.5 and TRPV1. Laser stimulation is a non-invasive and sensitive method for assessing the initial IENF loss, and regenerating nerve fibres. SIGNIFICANCE Assessing skin biopsies by PGP9.5 immunostaining alone may miss significant diagnostic and prognostic information regarding regenerating nerve fibres, if other approaches are neglected, e.g. LEPs or GAP-43 immunostaining.
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Affiliation(s)
- Michael Ragé
- Unité READ, Faculty of Medicine, Université catholique de Louvain, Brussels, Belgium
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Effect of lingual nerve block on burning mouth syndrome (stomatodynia): a randomized crossover trial. Pain 2010; 149:27-32. [PMID: 20083352 DOI: 10.1016/j.pain.2009.11.016] [Citation(s) in RCA: 87] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2009] [Revised: 10/13/2009] [Accepted: 11/13/2009] [Indexed: 11/22/2022]
Abstract
Burning mouth syndrome (stomatodynia) is associated with changes of a neuropathic nature the main location of which, peripheral or central, remains unknown. A randomised, double-blind crossover design was used to investigate the effects of lingual nerve block on spontaneous burning pain and a possible correlation with the effects of topical clonazepam, the patient's response to a psychological questionnaire, and the taste and heat thresholds. The spontaneous burning was measured with a visual analogue scale (VAS) just before and 15 min after injection. The decreases in VAS score after lidocaine or saline injection were not significantly different (2.7+/-3.9 and 2.0+/-2.6, respectively; n=20). However, two groups of patients could be identified: in a "peripheral group" (n=10) the VAS decrease due to lingual nerve injection was 4.3+/-3.1cm after lidocaine and 0.9+/-0.3 cm after saline (p=0.02). In a "central group" (n=7), there were an increase in pain intensity score (-0.8+/-2.6 cm) after lidocaine and a decrease (1.5+/-3.0 cm) after saline (p=0.15). An increase in the hospital anxiety and depression (HAD) score and a decreased taste sensitivity and heat pain threshold of painful oral area were seen in patients compared with age-and-sex-matched controls (p<0.05). Topical clonazepam treatment tended to be more effective (p=0.07) and HAD score lower (p<0.03) in the peripheral than in the central group. These results suggest that the neuropathic disorder associated with stomatodynia may be predominantly peripheral, central or mixed depending on the individual. Topical application of clonazepam and HAD may serve as indicators of which mechanism is dominating.
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Functional and structural nerve fiber findings in heterozygote patients with Fabry disease. Pain 2009; 145:237-45. [DOI: 10.1016/j.pain.2009.06.032] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2008] [Revised: 04/08/2009] [Accepted: 06/24/2009] [Indexed: 11/21/2022]
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Canaux potassiques TREK-1 : cibles moléculaires pour la découverte de nouveaux antalgiques ? ACTA ACUST UNITED AC 2008. [DOI: 10.1007/s11724-008-0108-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Mitani O, Masui K, Tsujimoto H, Jinbo K, Watanabe Y, Ohkura T, Taya K, Ikeda H. Histopathological Changes of Streptozotocin-induced Painful Diabetes and Antihyperalgesic Effect of Capsaicin Cream in Rats. J Toxicol Pathol 2008. [DOI: 10.1293/tox.21.97] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Osamu Mitani
- Central Research Laboratory, Maruishi Pharmaceutical Co., Ltd
| | - Kuniharu Masui
- Central Research Laboratory, Maruishi Pharmaceutical Co., Ltd
| | | | - Keisuke Jinbo
- Central Research Laboratory, Maruishi Pharmaceutical Co., Ltd
| | | | - Takako Ohkura
- Central Research Laboratory, Maruishi Pharmaceutical Co., Ltd
| | - Koji Taya
- Central Research Laboratory, Maruishi Pharmaceutical Co., Ltd
| | - Hitoshi Ikeda
- Central Research Laboratory, Maruishi Pharmaceutical Co., Ltd
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Lauria G, Devigili G. Skin biopsy as a diagnostic tool in peripheral neuropathy. ACTA ACUST UNITED AC 2007; 3:546-57. [PMID: 17914343 DOI: 10.1038/ncpneuro0630] [Citation(s) in RCA: 98] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2007] [Accepted: 07/31/2007] [Indexed: 12/24/2022]
Abstract
Skin biopsy is a safe, minimally invasive, painless and cheap tool for providing diagnostic information on small nerve fibers, which are invisible to routine neurophysiological tests. Biopsy can be performed in hairy skin to investigate unmyelinated and thinly myelinated fibers and in glabrous skin to examine large myelinated fibers. Morphometric analysis of skin nerves is readily accomplished through the use of immunohistochemical techniques, and has proved to be reliable, reproducible and unaffected by the severity of neuropathy. One further advantage of skin biopsy over conventional nerve biopsy is that it allows somatic nerve fibers to be distinguished from autonomic nerve fibers. Morphological changes, axonal degeneration and abnormal regeneration occur in cutaneous nerves very early in the course of peripheral neuropathies, making skin biopsy a promising tool for investigating the progression of neuropathy and the effect of neuroprotective treatments in clinical practice and trials. This article reviews the techniques that are used to investigate the innervation of human skin, the possible uses of skin biopsy in diagnosing and monitoring peripheral neuropathies, and correlations between skin biopsy findings and those of other diagnostic methods.
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Affiliation(s)
- Giuseppe Lauria
- Neuromuscular Diseases Unit, National Neurological Institute Carlo Besta, Via Celoria 11, 20133 Milan, Italy.
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Abstract
Skin biopsy has been widely used in recent years for the investigation of small-calibre sensory nerves, including somatic unmyelinated intraepidermal nerve fibres, dermal myelinated nerve fibres, and autonomic nerve fibres in peripheral neuropathies, with different techniques for tissue processing and nerve fibre assessment. Here, we review the techniques for skin biopsy, the processing and assessment of the biopsy sample, their possible uses in different types of peripheral neuropathy, and their use in the follow-up of patients and in clinical trials. We also review the association between morphological measures of skin innervation and function and the limits of this method in the aetiological classification of peripheral neuropathies.
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Affiliation(s)
- Claudia Sommer
- Department of Neurology, University of Würzburg, Germany.
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Kalantzis A, Robinson PP, Loescher AR. Effects of capsaicin and menthol on oral thermal sensory thresholds. Arch Oral Biol 2006; 52:149-53. [PMID: 17045956 DOI: 10.1016/j.archoralbio.2006.09.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2005] [Revised: 09/07/2006] [Accepted: 09/08/2006] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To determine the long-term effect of capsaicin and short-term effect of menthol on oral thermal thresholds. DESIGN The thresholds for cold detection (CDT), warm detection (WDT), cold pain (CPT) and warm pain (WPT) were determined in 11 regular chilli-eaters (capsaicin group) and 11 control subjects that were closely matched for age, gender and ethnicity. The effect of menthol was determined by asking all 22 participants to suck a lozenge containing 0.52% menthol for 5min. RESULTS An ANOVA revealed a significant difference between the capsaicin and control groups (P=0.014), with the greatest difference in the WDT (capsaicin group 4.7+/-2.7[S.D.] degrees C; control group 2.3+/-2.2 degrees C). Immediately after sucking a menthol lozenge there was a significant rise in the CDT (2.2+/-1.1 degrees C to 5.9+/-6.2 degrees C; P<0.01) and WDT (3.6+/-2.7 degrees C to 7.6+/-4.4 degrees C; P<0.001). CONCLUSIONS The consumption of foods containing capsaicin and menthol significantly alters thermal sensory thresholds in the oral cavity. Dietary habits should therefore be taken into account when intra-oral thermal thresholds are determined.
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Affiliation(s)
- A Kalantzis
- University of Sheffield, Claremont Crescent, UK
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Alloui A, Zimmermann K, Mamet J, Duprat F, Noël J, Chemin J, Guy N, Blondeau N, Voilley N, Rubat-Coudert C, Borsotto M, Romey G, Heurteaux C, Reeh P, Eschalier A, Lazdunski M. TREK-1, a K+ channel involved in polymodal pain perception. EMBO J 2006; 25:2368-76. [PMID: 16675954 PMCID: PMC1478167 DOI: 10.1038/sj.emboj.7601116] [Citation(s) in RCA: 303] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2006] [Accepted: 04/04/2006] [Indexed: 12/14/2022] Open
Abstract
The TREK-1 channel is a temperature-sensitive, osmosensitive and mechano-gated K+ channel with a regulation by Gs and Gq coupled receptors. This paper demonstrates that TREK-1 qualifies as one of the molecular sensors involved in pain perception. TREK-1 is highly expressed in small sensory neurons, is present in both peptidergic and nonpeptidergic neurons and is extensively colocalized with TRPV1, the capsaicin-activated nonselective ion channel. Mice with a disrupted TREK-1 gene are more sensitive to painful heat sensations near the threshold between anoxious warmth and painful heat. This phenotype is associated with the primary sensory neuron, as polymodal C-fibers were found to be more sensitive to heat in single fiber experiments. Knockout animals are more sensitive to low threshold mechanical stimuli and display an increased thermal and mechanical hyperalgesia in conditions of inflammation. They display a largely decreased pain response induced by osmotic changes particularly in prostaglandin E2-sensitized animals. TREK-1 appears as an important ion channel for polymodal pain perception and as an attractive target for the development of new analgesics.
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Affiliation(s)
- Abdelkrim Alloui
- Laboratoire de Pharmacologie Médicale EA 3848 INSERM/Faculté de Médecine/CHU, Clermont-Ferrand, France
| | - Katharina Zimmermann
- Department of Physiology and Pathophysiology, University Erlangen-Nuremberg, Erlangen, Germany
| | - Julien Mamet
- Institut de Pharmacologie Moléculaire et Cellulaire, CNRS-Université de Nice, Institut Paul Hamel, Sophia Antipolis, Valbonne, France
| | - Fabrice Duprat
- Institut de Pharmacologie Moléculaire et Cellulaire, CNRS-Université de Nice, Institut Paul Hamel, Sophia Antipolis, Valbonne, France
| | - Jacques Noël
- Institut de Pharmacologie Moléculaire et Cellulaire, CNRS-Université de Nice, Institut Paul Hamel, Sophia Antipolis, Valbonne, France
| | - Jean Chemin
- Institut de Pharmacologie Moléculaire et Cellulaire, CNRS-Université de Nice, Institut Paul Hamel, Sophia Antipolis, Valbonne, France
| | - Nicolas Guy
- Institut de Pharmacologie Moléculaire et Cellulaire, CNRS-Université de Nice, Institut Paul Hamel, Sophia Antipolis, Valbonne, France
| | - Nicolas Blondeau
- Institut de Pharmacologie Moléculaire et Cellulaire, CNRS-Université de Nice, Institut Paul Hamel, Sophia Antipolis, Valbonne, France
| | - Nicolas Voilley
- Institut de Pharmacologie Moléculaire et Cellulaire, CNRS-Université de Nice, Institut Paul Hamel, Sophia Antipolis, Valbonne, France
| | - Catherine Rubat-Coudert
- Laboratoire de Pharmacologie Médicale EA 3848 INSERM/Faculté de Médecine/CHU, Clermont-Ferrand, France
| | - Marc Borsotto
- Institut de Pharmacologie Moléculaire et Cellulaire, CNRS-Université de Nice, Institut Paul Hamel, Sophia Antipolis, Valbonne, France
| | - Georges Romey
- Institut de Pharmacologie Moléculaire et Cellulaire, CNRS-Université de Nice, Institut Paul Hamel, Sophia Antipolis, Valbonne, France
| | - Catherine Heurteaux
- Institut de Pharmacologie Moléculaire et Cellulaire, CNRS-Université de Nice, Institut Paul Hamel, Sophia Antipolis, Valbonne, France
| | - Peter Reeh
- Department of Physiology and Pathophysiology, University Erlangen-Nuremberg, Erlangen, Germany
| | - Alain Eschalier
- Laboratoire de Pharmacologie Médicale EA 3848 INSERM/Faculté de Médecine/CHU, Clermont-Ferrand, France
| | - Michel Lazdunski
- Institut de Pharmacologie Moléculaire et Cellulaire, CNRS-Université de Nice, Institut Paul Hamel, Sophia Antipolis, Valbonne, France
- Institut de Pharmacologie Moléculaire et Cellulaire, CNRS-Université de Nice, Institut Paul Hamel, 660, Route des Lucioles, Sophia Antipolis, 06560 Valbonne, France. Tel.: +33 493 957702; Fax: +33 493 957704; E-mail:
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Lauria G, Cornblath DR, Johansson O, McArthur JC, Mellgren SI, Nolano M, Rosenberg N, Sommer C. EFNS guidelines on the use of skin biopsy in the diagnosis of peripheral neuropathy. Eur J Neurol 2006; 12:747-58. [PMID: 16190912 DOI: 10.1111/j.1468-1331.2005.01260.x] [Citation(s) in RCA: 387] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Skin biopsy has become a widely used tool to investigate small calibre sensory nerves including somatic unmyelinated intraepidermal nerve fibres (IENF), dermal myelinated nerve fibres, and autonomic nerve fibres in peripheral neuropathies and other conditions. Different techniques for tissue processing and nerve fibre evaluation have been used. In March 2004, a Task Force was set up under the auspices of the European Federation of Neurological Societies (EFNS) with the aim of developing guidelines on the use of skin biopsy in the diagnosis of peripheral neuropathies. We searched the Medline database from 1989, the year of the first publication describing the innervation of human skin using immunostaining with anti-protein-gene-product 9.5 (PGP 9.5) antibodies, to 31 March 2005. All pertinent papers were rated according to the EFNS guidance. The final version of the guidelines was elaborated after consensus amongst members of the Task Force was reached. For diagnostic purposes in peripheral neuropathies, we recommend performing a 3-mm punch skin biopsy at the distal leg and quantifying the linear density of IENF in at least three 50-mum thick sections per biopsy, fixed in 2% PLP or Zamboni's solution, by bright-field immunohistochemistry or immunofluorescence with anti-PGP 9.5 antibodies (level A recommendation). Quantification of IENF density closely correlated with warm and heat-pain threshold, and appeared more sensitive than sensory nerve conduction study and sural nerve biopsy in diagnosing small-fibre sensory neuropathy. Diagnostic efficiency and predictive values of this technique were very high (level A recommendation). Confocal microscopy may be particularly useful to investigate myelinated nerve fibres, dermal receptors and dermal annex innervation. In future, the diagnostic yield of dermal myelinated nerve fibre quantification and of sweat gland innervation should be addressed. Longitudinal studies of IENF density and regeneration rate are warranted to correlate neuropathological changes with progression of neuropathy and to assess the potential usefulness of skin biopsy as an outcome measure in peripheral neuropathy trials (level B recommendation). In conclusion, punch skin biopsy is a safe and reliable technique (level A recommendation). Training in an established cutaneous nerve laboratory is recommended before using skin biopsy as a diagnostic tool in peripheral neuropathies. Quality control at all levels is mandatory.
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Affiliation(s)
- G Lauria
- Immunology and Muscular Pathology Unit, Department of Clinical Neurosciences, National Neurological Institute Carlo Besta, Milan, Italy.
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Sommer C, Lauria G. Chapter 41 Painful small-fiber neuropathies. HANDBOOK OF CLINICAL NEUROLOGY 2006; 81:621-633. [PMID: 18808863 DOI: 10.1016/s0072-9752(06)80045-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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Malmberg AB, Mizisin AP, Calcutt NA, von Stein T, Robbins WR, Bley KR. Reduced heat sensitivity and epidermal nerve fiber immunostaining following single applications of a high-concentration capsaicin patch. Pain 2004; 111:360-367. [PMID: 15363880 DOI: 10.1016/j.pain.2004.07.017] [Citation(s) in RCA: 113] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2003] [Revised: 06/02/2004] [Accepted: 07/15/2004] [Indexed: 11/15/2022]
Abstract
Capsaicin-containing plant extracts have been used as topical treatments for a variety of pain syndromes for many centuries. Current products containing capsaicin in low concentrations (usually 0.025-0.075% w/w) have shown efficacy against a variety of pain conditions in clinical studies. However, in order to produce significant analgesic effects, these formulations require frequent re-dosing, often as much as three to five times daily for several weeks. Previous functional and immunohistochemical studies following prolonged exposures to low-concentration capsaicin cream suggested that the duration and onset of analgesic efficacy correlate with a reduction of cutaneous nociceptive sensory nerve fiber responsiveness and immunostaining. The purpose of the present study was to determine whether a single topical application of a high-concentration capsaicin-containing (8%w/w) patch for 120 min or less would induce similar effects on cutaneous nociceptive nerve fibers. Seven days following patch application, changes in heat and cold perception thresholds were determined by quantitative sensory testing and punch biopsies were collected to assess epidermal nerve fiber (ENF) immunostaining density at the application site using PGP 9.5 as a marker. The results show a significant reduction of heat, but not cold, sensitivity and reduction of ENF immunostaining with high-capsaicin concentration patch applications for 60 or 120 min, compared to placebo patch applications. Application sites exposed to low-capsaicin concentration (0.04%w/w) patches for 120 min or high-concentration patches for 30 min were not significantly different from placebo with respect to either thermal threshold detection or ENF immunostaining. The ability of a single 60 min high-concentration patch application to mimic effects produced by prolonged exposure to low-concentration capsaicin creams suggests a new approach to the management of chronic pain syndromes.
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Affiliation(s)
- Annika B Malmberg
- NeurogesX, Inc., 981F Industrial Road, San Carlos, CA 94070, USA Department of Pathology, University of California, San Diego, 9500 Gillman Drive, La Jolla, CA 92093, USA
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Kennedy WR. Opportunities afforded by the study of unmyelinated nerves in skin and other organs. Muscle Nerve 2004; 29:756-67. [PMID: 15170608 DOI: 10.1002/mus.20062] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Neurological practice is mainly focused on signs and symptoms of disorders that involve functions governed by myelinated nerves. Functions controlled by unmyelinated nerve fibers have necessarily remained in the background because of the inability to consistently stain, image, or construct clinically applicable neurophysiological tests of these nerves. The situation has changed with the introduction of immunohistochemical methods and confocal microscopy into clinical medicine, as these provide clear images of thin unmyelinated nerves in most organs. One obvious sign of change is the increasing number of reports from several laboratories of the pathological alterations of cutaneous nerves in skin biopsies from patients with a variety of clinical conditions. This study reviews recent methods to stain and image unmyelinated nerves as well as the use of these methods for diagnosing peripheral neuropathy, for experimental studies of denervation and reinnervation in human subjects, and for demonstrating the vast array of unmyelinated nerves in internal organs. The new ability to examine the great variety of nerves in different organs opens opportunities and creates challenges and responsibilities for neurologists and neuroscientists.
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Affiliation(s)
- William R Kennedy
- Department of Neurology, University of Minnesota Hospital, MMC 187, 420 Delaware Street SE, Minneapolis, Minnesota 55455-0374, USA.
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Kennedy WR. Chapter 2 Unmyelinated nerves, challenges, and opportunities: skin biopsy and beyond. ACTA ACUST UNITED AC 2004; 57:8-14. [PMID: 16106601 DOI: 10.1016/s1567-424x(09)70338-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Affiliation(s)
- William R Kennedy
- Department of Neurology, University of Minnesota, MMC 187, 420 Delaware St. SE, Minneapolis, MI 55455, USA.
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Gibson SJ, Farrell M. A Review of Age Differences in the Neurophysiology of Nociception and the Perceptual Experience of Pain. Clin J Pain 2004; 20:227-39. [PMID: 15218407 DOI: 10.1097/00002508-200407000-00004] [Citation(s) in RCA: 259] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To better understand the nature of age differences in pain and nociception with the aging of the worlds' population. METHODS The evidence from numerous neurophysiologic and psychological studies suggest a small, but demonstrable age-related impairment in the early warning functions of pain. The increase in pain perception threshold and the widespread change in the structure and function of peripheral and CNS nociceptive pathways may place the older person at greater risk of injury. Moreover, the reduced efficacy of endogenous analgesic systems, a decreased tolerance of pain and the slower resolution of postinjury hyperalgesia may make it more difficult for the older adult to cope, once injury has occurred. RESULTS These age-related changes may be best conceptualized as a reduced capacity in the functional reserve of the pain system, at both ends of the intensity spectrum. DISCUSSION The clinical implications are obvious; older persons are likely to be especially vulnerable to the negative impacts of pain and pain associated events.
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Affiliation(s)
- Stephen J Gibson
- Department of Medicine, University of Melbourne, Victoria, Australia.
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Granot M, Sprecher E, Yarnitsky D. Psychophysics of phasic and tonic heat pain stimuli by quantitative sensory testing in healthy subjects. Eur J Pain 2003; 7:139-43. [PMID: 12600795 DOI: 10.1016/s1090-3801(02)00087-3] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
UNLABELLED The increased use of quantitative sensory testing in the study of pain raises the need to characterize various aspects of psychophysical response to noxious stimulation in healthy subjects. The present study aims to address several issues regarding the use of heat pain stimuli: (a) Are pain scores for short-term repeated phasic stimuli consistent? (b) Does an exposure to tonic heat pain stimulus cause sensitization and change the scores for subsequent phasic stimuli? and (c) Are pain scores for phasic and tonic heat pain correlated? To address these questions, a series of four phasic heat pain stimuli of 47 degrees C were given to the forearms of 70 healthy volunteers, over the course of an hour. Pain scores by Visual Analog Scale (VAS) were obtained for each stimulus. In 50 subjects, a tonic heat pain of 70s duration at 47.5 degrees C was given between the first and second phasic stimuli. Pain scores were obtained at four points along this tonic stimulus. Repeated measures ANOVA and a sensitive post hoc analysis indicated that, while the pain perception was reduced on the second, nearly immediate trial, subsequent VAS scores of pain perception were not different from the first (#1: 35.2+/-19.2; #2: 31.4+/-20.2, #3: 33.0+/-21.6; and #4: 33.2+/-20.1, respectively), with strong correlation among the phasic tests. The average tonic pain score was 53.7+/-23.1. Administration of tonic pain stimuli did not result in different VAS scores of subsequent phasic pain stimuli, compared to those subjects who did not receive tonic pain stimuli. Tonic and phasic pain were positively correlated (e.g., r=0.45,p<0.001 for the first phasic stimuli). However, no relation was found between the level of perceived pain, either for phasic or for tonic stimuli, and presence or absence of temporal summation during the tonic pain. IN CONCLUSION (i) phasic pain scores assessments at 30' and 60' after baseline is consistent; (ii) tonic heat pain, despite relatively high VAS scores, does not cause a change in the scoring of subsequent phasic stimuli; and (iii) phasic and tonic pain scores correlate with each other. Thus, the normal pattern of pain perception is stable and not altered by single tonic pain stimulation.
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Affiliation(s)
- Michal Granot
- Department of Nursing, Faculty of Health and Welfare Studies, University of Haifa, Haifa, Israel.
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Zhang HW, Iida Y, Andoh T, Nojima H, Murata J, Saiki I, Kuraishi Y. Mechanical hypersensitivity and alterations in cutaneous nerve fibers in a mouse model of skin cancer pain. J Pharmacol Sci 2003; 91:167-70. [PMID: 12686763 DOI: 10.1254/jphs.91.167] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
Melanoma inoculation induced marked mechanical allodynia and hyperalgesia in the periphery of the melanoma mass in mice from about day 10 post-inoculation. In the middle of the tumor, there were slight hyperalgesia and response disappearance in the early and late phases, respectively. PGP9.5-like immunoreactivities increased in the epidermis of the periphery of the tumor and disappeared from the dermis of the middle on day 18 post-inoculation, without apparent alterations on day 10. When using this pain model, one should consider the tumor site-dependent responses.
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Affiliation(s)
- Hong-Wei Zhang
- Department of Applied Pharmacology, Faculty of Pharmaceutical Sciences, Toyama, Japan
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Abstract
Small-fiber neuropathy is a common disorder. It is often "idiopathic" and typically presents with painful feet in patients over the age of 60. Autoimmune mechanisms are often suspected, but rarely identified. Known causes of small-fiber neuropathy include diabetes mellitus, amyloidosis, toxins, and inherited sensory and autonomic neuropathies. Occasionally, small-fiber neuropathy is diffuse or multifocal. Depending on the type of small-fiber neuropathy, autonomic dysfunction can be significant or subclinical. Diagnosis is made on the basis of the clinical features, normal nerve conduction studies, and abnormal specialized tests of small-fiber function. These specialized studies include assessment of epidermal nerve fiber density as well as sudomotor, quantitative sensory, and cardiovagal testing. The sensitivities of these tests range from 59-88%. Each has certain advantages and disadvantages, and the tests may be complementary. Unless an underlying disease is identified, treatment is usually directed toward alleviation of neuropathic pain.
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Affiliation(s)
- David Lacomis
- Department of Neurology, University of Pittsburgh School of Medicine, UPMC Presbyterian, 200 Lothrop Street, F878, Pittsburgh, Pennsylvania 15213, USA.
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