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Kalia H, Abd-Elsayed A, Malinowski M, Burkey A, Abdallah RT, Sivanesan E, Malik T, Tolba R, Eshraghi Y, Ferguson K, Schnur M, Raslan A, Guirguis M, Russo M, Slavin KV. Educational Curriculum for Peripheral Nerve Stimulation Developed by the North American Neuromodulation Society. Neuromodulation 2022; 26:483-489. [PMID: 36526547 DOI: 10.1016/j.neurom.2022.09.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 08/15/2022] [Accepted: 09/20/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Peripheral nerve stimulation (PNS) is an effective neuromodulation therapy for chronic neuropathic and nociceptive pain. Although the total number of PNS implantations has increased over the last decade, no curriculum exists to guide training and learning of this therapy. The goal of the North American Neuromodulation Society (NANS) education committee is to develop a series of competency-based curriculums for neuromodulation therapies. The PNS curriculum is the latest part of such series, following the curriculums for spinal cord stimulation and intrathecal drug delivery system. MATERIALS AND METHODS A multidisciplinary task force (anesthesiology, physical medicine and rehabilitation, neurosurgery, preventive medicine and public health, and neurology) was created by the educational committee of NANS to develop a PNS curriculum in accordance with the Accreditation Council for Graduate Medical Education (ACGME) milestones. The curriculum was created based on the best available evidence and expert knowledge (from our task force members) of available PNS systems. The final PNS curriculum was approved by the NANS board. RESULTS A PNS curriculum was developed by the task force. Milestones included professionalism, practice-based learning, interpersonal communication, medical knowledge, systems-based practice, procedural skills, and patient care. Each milestone was defined into three categories: early learner, advanced learner, and practitioner. CONCLUSIONS This manuscript provides a PNS training curriculum developed by a multidisciplinary task force of the NANS educational committee in accordance with the milestones described by ACGME for basic learners, advanced learners, and practitioners. This curriculum will help provide a structured training and evaluation process for obtaining proficiency in PNS treatment(s).
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Safarpour Y, Jabbari B. Botulinum toxin treatment of pain syndromes -an evidence based review. Toxicon 2018; 147:120-128. [PMID: 29409817 DOI: 10.1016/j.toxicon.2018.01.017] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 08/18/2017] [Accepted: 01/28/2018] [Indexed: 02/07/2023]
Abstract
This review evaluates the existing level of evidence for efficacy of BoNTs in different pain syndromes using the recommended efficacy criteria from the Assessment and Therapeutic Subcommittee of the American Academy of Neurology. There is a level A evidence (effective) for BoNT therapy in post-herpetic neuralgia, trigeminal neuralgia, and posttraumatic neuralgia. There is a level B evidence (probably effective) for diabetic neuropathy, plantar fasciitis, piriformis syndrome, pain associated with total knee arthroplasty, male pelvic pain syndrome, chronic low back pain, male pelvic pain, and neuropathic pain secondary to traumatic spinal cord injury. BoNTs are possibly effective (Level C -one class II study) for female pelvic pain, painful knee osteoarthritis, post-operative pain in children with cerebral palsy after adductor release surgery, anterior knee pain with vastus lateralis imbalance. There is a level B evidence (one class I study) that BoNT treatment is probably ineffective in carpal tunnel syndrome. For myofascial pain syndrome, the level of evidence is U (undetermined) due to contradicting results. More high quality (Class I) studies and studies with different types of BoNTs are needed for better understanding of the role of BoNTs in pain syndromes.
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Affiliation(s)
- Yasaman Safarpour
- Department of Medicine, Division of Nephrology, University of California, Irvine (UCI), CA, USA
| | - Bahman Jabbari
- Department of Neurology, Yale University School of Medicine, New Haven, CT, USA.
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Obradović ALJ, Scarpa J, Osuru HP, Weaver JL, Park JY, Pathirathna S, Peterkin A, Lim Y, Jagodic MM, Todorovic SM, Jevtovic-Todorovic V. Silencing the α2 subunit of γ-aminobutyric acid type A receptors in rat dorsal root ganglia reveals its major role in antinociception posttraumatic nerve injury. Anesthesiology 2015; 123:654-67. [PMID: 26164299 PMCID: PMC4568754 DOI: 10.1097/aln.0000000000000767] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND Neuropathic pain (NPP) is likely the result of repetitive high-frequency bursts of peripheral afferent activity leading to long-lasting changes in synaptic plasticity in the spinal dorsal horn. Drugs that promote γ-aminobutyric acid (GABA) activity in the dorsal horn provide partial relief of neuropathic symptoms. The authors examined how in vivo silencing of the GABA receptor type A (GABAA) α2 gene in dorsal root ganglia (DRG) controls NPP. METHODS After crush injury to the right sciatic nerve of female rats, the α2 GABAA antisense and mismatch oligodeoxynucleotides or NO-711 (a GABA uptake inhibitor) were applied to the L5 DRG. In vivo behavioral assessment of nociception was conducted before the injury and ensuing 10 days (n = 4 to 10). In vitro quantification of α2 GABAA protein and electrophysiological studies of GABAA currents were performed on acutely dissociated L5 DRG neurons at relevant time points (n = 6 to 14). RESULTS NPP postcrush injury of a sciatic nerve in adult female rats coincides with significant down-regulation of the α2 subunit expression in the ipsilateral DRG (approximately 30%). Selective down-regulation of α2 expression in DRGs significantly worsens mechanical (2.55 ± 0.75 to 5.16 ± 1.16) and thermal (7.97 ± 0.96 to 5.51 ± 0.75) hypersensitivity in crush-injured animals and causes development of significant mechanical (2.33 ± 0.40 to 5.00 ± 0.33) and thermal (10.80 ± 0.29 to 7.34 ± 0.81) hypersensitivity in sham animals (data shown as mean ± SD). Conversely, up-regulation of endogenous GABA via blockade of its uptake in DRG alleviates NPP. CONCLUSION The GABAA receptor in the DRG plays an important role in pathophysiology of NPP caused by sciatic nerve injury and represents promising target for novel pain therapies.
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Affiliation(s)
- Aleksandar LJ Obradović
- Department of Anesthesiology, University of Virginia Health System, Charlottesville, VA, USA
- Department of Physiology, University of Belgrade School of Pharmacy, Belgrade, Serbia
| | - Joseph Scarpa
- Department of Anesthesiology, University of Virginia Health System, Charlottesville, VA, USA
- Icahn Institute for Genomics and Multiscale Biology, Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Hari P Osuru
- Department of Anesthesiology, University of Virginia Health System, Charlottesville, VA, USA
| | - Janelle L Weaver
- Department of Anesthesiology, University of Virginia Health System, Charlottesville, VA, USA
| | - Ji-Yong Park
- Department of Anesthesiology, University of Virginia Health System, Charlottesville, VA, USA
- Department of Anesthesiology and Pain Medicine, College of Medicine, Korea University, Seoul, Republic of Korea
| | - Sriyani Pathirathna
- Department of Anesthesiology, University of Virginia Health System, Charlottesville, VA, USA
| | - Alexander Peterkin
- Department of Anesthesiology, University of Virginia Health System, Charlottesville, VA, USA
| | - Yunhee Lim
- Department of Anesthesiology, University of Virginia Health System, Charlottesville, VA, USA
- Department of Anesthesiology and Pain Medicine, Sanggye Paik Hospital, College of Medicine, Inje University, Seoul, Republic of Korea
| | - Miljenko M Jagodic
- Department of Anesthesiology, University of Virginia Health System, Charlottesville, VA, USA
| | - Slobodan M Todorovic
- Department of Anesthesiology, University of Virginia Health System, Charlottesville, VA, USA
- Department of Neuroscience, University of Virginia Health System, Charlottesville, VA, USA
| | - Vesna Jevtovic-Todorovic
- Department of Anesthesiology, University of Virginia Health System, Charlottesville, VA, USA
- Department of Neuroscience, University of Virginia Health System, Charlottesville, VA, USA
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Neumeister MW. Botulinum toxin type A in the treatment of Raynaud's phenomenon. J Hand Surg Am 2010; 35:2085-92. [PMID: 21134617 DOI: 10.1016/j.jhsa.2010.09.019] [Citation(s) in RCA: 100] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2010] [Accepted: 09/16/2010] [Indexed: 02/02/2023]
Abstract
PURPOSE Raynaud's phenomenon is a vasospastic disorder of the palmar and digital vessels of the hand and feet that can lead to ischemic ulcers, pain, and loss of function. This study is a review of patients I have injected with botulinum toxin type A for patients with Raynaud's phenomenon. METHODS Raynaud's patients were injected with 50 to 100 units of onabotulinumtoxinA to improve perfusion of the digits. An institutional review board-approved retrospective review was undertaken to analyze outcomes. Laser Doppler scans were performed before and after injection to quantitatively measure perfusion. RESULTS A total of 14 men and 19 women with Raynaud's phenomenon were injected with onabotulinumtoxinA. All but 5 patients experienced improved vascularity and relief of pain. Laser Doppler scans illustrated notable improvement in perfusion. Five patients had repeat injections for recurrent pain. CONCLUSIONS Botulinum toxin appears to improve perfusion of the hand after direct injection around the neurovascular bundles. Further investigations are warranted to identify the exact mode of action in relieving vasospasm and alleviating pain.
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Affiliation(s)
- Michael W Neumeister
- Division of Plastic Surgery, Southern Illinois University School of Medicine, Springfield, IL 62794, USA.
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Neumeister MW, Chambers CB, Herron MS, Webb K, Wietfeldt J, Gillespie JN, Bueno RA, Cooney CM. Botox Therapy for Ischemic Digits. Plast Reconstr Surg 2009; 124:191-201. [DOI: 10.1097/prs.0b013e3181a80576] [Citation(s) in RCA: 110] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Al Malyan M, Becchi C, Nikkola L, Viitanen P, Boncinelli S, Chiellini F, Ashammakhi N. Polymer-based biodegradable drug delivery systems in pain management. J Craniofac Surg 2006; 17:302-13. [PMID: 16633180 DOI: 10.1097/00001665-200603000-00018] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Pain is an unpleasant sensory experience commonly produced by damage to bodily tissues and it is one of the most significant public health problems, because 21.5% of the world population is estimated to suffer from pain. It results in a total loss of more than 165 billion US dollars each year in the United States alone. Pain reflects a mixture of various pathophysiologic, psychologic, and genetic contributions. When undertreated, pain usually results in serious immune and metabolic upset. Therefore, it requires wide understanding and intensive effort for a better management. Currently, pain control is limited by the modest efficiency of the used drugs, the serious side effects of these drugs, and the inefficacy of conventional drug administration. By the introduction of the technology of biodegradable controlled-release devices into clinical practice, pain control not only benefits from these novel methods for a better delivery of various drugs, but the side effects of the drugs are reduced because use of the devices improves patient compliance. Biodegradable controlled-release devices are polymer-based devices that are designed to deliver drugs locally in a predesigned manner. Recently, there was a high interest in developing these devices for the delivery of different drugs used for pain control. This paper first highlights the dimensions and basics of the problem of pain. Then, it presents an overview of the biodegradable polymers that are used in drug delivery systems and summarizes the studies carried out on these systems in the field of pain management. We refer to our experience in developing a device for multimodal drug delivery, including the use of nanotechnology. Future perspectives are also presented.
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Affiliation(s)
- Mohamed Al Malyan
- Department of Medical and Surgical Critical Care, Section of Anaesthesia and Intensive Care, Florence University, Florence, Italy
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Burgess C, Ravenscroft AJ. The lidocaine patch: a useful addition to the pain clinic armamentarium. Anaesthesia 2006; 61:412. [PMID: 16548983 DOI: 10.1111/j.1365-2044.2006.04604.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Maneuf YP, Blake R, Andrews NA, McKnight AT. Reduction by gabapentin of K+-evoked release of [3H]-glutamate from the caudal trigeminal nucleus of the streptozotocin-treated rat. Br J Pharmacol 2004; 141:574-9. [PMID: 14744819 PMCID: PMC1574225 DOI: 10.1038/sj.bjp.0705579] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Recently, we showed that gabapentin can inhibit a facilitatory effect of substance P (SP) on K(+)-evoked glutamate release in rat trigeminal slices (Maneuf et al., 2001), and we have now examined the effect of gabapentin on glutamate release in the trigeminal slice from the streptozotocin (STZ)-treated rat. 1. At 4 weeks following STZ treatment (50 mg kg(-1) i.p.), blood glucose was increased in the majority of cases, compared to the control level. All the treated animals showed a significant degree (P<0.001) of tactile allodynia (assessed using von Frey filaments) that did not appear to correlate with blood glucose levels. 2. In this study, we demonstrated that, after STZ treatment, 30 microM gabapentin reduced K(+)-evoked release of [(3)H]-glutamate in either normal (11 mM) or high (30 mM) glucose conditions by 24 and 22%, respectively. In the normal rat, gabapentin (up to 100 microM) is ordinarily unable to affect release of glutamate from the trigeminal slice. 3. The uptake of glutamate in Sp5C punches from streptozotocin-treated rats was reduced under normal glucose conditions (41.7% of control), whereas high glucose restored uptake to normal (84.7% of control). 4. The addition of 1 microm substance P potentiated the evoked release of glutamate in both normal (40% increase) and high glucose (28%), and this was blocked by gabapentin (30 microM) in both conditions. It is interesting to speculate that this ability of gabapentin to reduce the release of glutamate in the trigeminal nucleus after streptozotocin treatment may be of relevance to the antihyperalgesic-allodynic actions of the drug.
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Affiliation(s)
- Y P Maneuf
- Cambridge Biotechnology Ltd, PO Box 230, Cambridge CB2 1XJ.
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Dogrul A, Gardell LR, Ossipov MH, Tulunay FC, Lai J, Porreca F. Reversal of experimental neuropathic pain by T-type calcium channel blockers. Pain 2003; 105:159-68. [PMID: 14499432 DOI: 10.1016/s0304-3959(03)00177-5] [Citation(s) in RCA: 164] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Experimental nerve injury results in exaggerated responses to tactile and thermal stimuli that resemble some aspects of human neuropathic pain. Neuronal hyperexcitability and neurotransmitter release have been suggested to promote such increased responses to sensory stimuli. Enhanced activity of Ca(2+) current is associated with increased neuronal activity and blockade of N- and P-types, but not L-type, calcium channels have been found to block experimental neuropathic pain. While T-type currents are believed to promote neuronal excitability and transmitter release, it is unclear whether these channels may also contribute to the neuropathic state. Rats were prepared with L(5)/L(6) spinal nerve ligation, and tactile and thermal hypersensitivities were established. Mibefradil or ethosuximide was administered either intraperitoneally, intrathecally (i.th.), or locally into the plantar aspect of the injured hindpaw. Systemic mibefradil or ethosuximide produced a dose-dependent blockade of both tactile and thermal hypersensitivities in nerve-injured rats; responses of sham-operated rats were unchanged. Local injection of mibefradil also blocked both end points. Ethosuximide, however, was inactive after local administration, perhaps reflecting its low potency when compared with mibefradil. Neither mibefradil nor ethosuximide given i.th. produced any blockade of neuropathic behaviors. The results presented here suggest that T-type calcium channels may play a role in the expression of the neuropathic state. The data support the view that selective T-type calcium channel blockers may have significant potential in the treatment of neuropathic pain states.
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Affiliation(s)
- Ahmet Dogrul
- Department of Pharmacology, Faculty of Medicine, Gulhane Medical Military Academy, Ankara, Turkey
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Neurophysiology of Cancer Pain: From the Laboratory to the Clinic. CURRENT REVIEW OF PAIN 2000; 3:214-225. [PMID: 10998677 DOI: 10.1007/s11916-999-0016-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Pain is one of the most distressing symptoms associated with cancer. Basic science research has provided much insight into the mechanisms of peripheral and central pain and the actions of new drugs. Despite these advances, pain accompanying malignancy can be difficult to treat. Pain most commonly presents when the tumor has invaded somatic,visceral, or neural structures. An understanding of pain mechanisms is essential when deciding on the appropriate treatment. New therapeutic options have been developed and will hopefully provide clinicians with tools to successfully alleviate cancer pain.
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Patel MK, Gonzalez MI, Bramwell S, Pinnock RD, Lee K. Gabapentin inhibits excitatory synaptic transmission in the hyperalgesic spinal cord. Br J Pharmacol 2000; 130:1731-4. [PMID: 10952660 PMCID: PMC1572282 DOI: 10.1038/sj.bjp.0703530] [Citation(s) in RCA: 82] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
In the present study we tested the effects of the antihyperalgesic compound gabapentin on dorsal horn neurones in adult spinal cord. Slices were taken from control and hyperalgesic animals suffering from streptozocin-induced diabetic neuropathy. At concentrations up to 100 microM, bath application failed to affect the resting membrane properties of dorsal horn neurones taken from both groups of animal. In contrast, bath application of gabapentin dramatically reduced the magnitude of the excitatory postsynaptic current (EPSC) in neurones taken from hyperalgesic animals without altering the magnitude of the EPSC in control animals. Using a paired pulse stimulation protocol, together with analysis of miniature EPSC's, it was possible to demonstrate that gabapentin mediated these effects via a pre-synaptic site of action.
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Affiliation(s)
- Manoj K Patel
- Parke-Davis Neuroscience Research Centre, Cambridge University Forvie Site, Robinson Way, Cambridge, CB2 2QB
| | - M Isabel Gonzalez
- Parke-Davis Neuroscience Research Centre, Cambridge University Forvie Site, Robinson Way, Cambridge, CB2 2QB
| | - Steven Bramwell
- Parke-Davis Neuroscience Research Centre, Cambridge University Forvie Site, Robinson Way, Cambridge, CB2 2QB
| | - Robert D Pinnock
- Parke-Davis Neuroscience Research Centre, Cambridge University Forvie Site, Robinson Way, Cambridge, CB2 2QB
| | - Kevin Lee
- Parke-Davis Neuroscience Research Centre, Cambridge University Forvie Site, Robinson Way, Cambridge, CB2 2QB
- Author for correspondence:
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