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Cillo JE, Godwin S, Becker E, Schorr R. Neurosensory Recovery Following Mental Nerve Skeletonization in Intraoral Open Reduction and Internal Fixation of Mandible Fractures. J Oral Maxillofac Surg 2020; 79:183-191. [PMID: 32961124 DOI: 10.1016/j.joms.2020.08.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 08/10/2020] [Accepted: 08/21/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE The purpose of this study was to evaluate neurosensory recovery after mental nerve skeletonization in open reduction and internal fixation (ORIF) of mandible fractures. METHODS This was a prospective nonrandomized observation study of adult subjects treated at a Level I trauma center between April 1, 2016 and December 31, 2019, with mental nerve skeletonization for ORIF of mandible fractures. Age, sex, and mandibular injury severity score (MISS), and functional sensory recovery (FSR) and subjective neurosensory recovery of skeletonized mental nerve were recorded at preoperative and regularly scheduled follow-up appointments. Uninomial and multinomial logistic regressions were conducted with a significance level of < 0.05. RESULTS Twenty-six subjects (all male) completed all the postoperative protocol requirements and were included in this study. All subjects had a loss of FSR (S0) and subjective neurosensation immediately after surgery. Half of the subjects achieved FSR (S3) and subjective neurosensory recovery (VAS < 4) an average of 42 days after surgery. All subjects improved FSR (S4) by 57 days and subjective neurosensory recovery by 90 days after surgery. These were independent of MISS but had decreased recovery time with increased age. No incidences of mental nerve neuropathic pain during the trial period were found. CONCLUSIONS FSR and subjective neurosensory recovery from mental nerve skeletonization in intraoral ORIF of mandible fractures was achieved in all subjects by the end of this study. Neurosensory recovery was independent of MISS but decreased with increased age. Initial inverse correlations between objective and subjective neurosensory assessments were insignificant at study completion. No incidences of neuropathic pain were identified during the time of this study. Mental nerve skeletonization in ORIF of mandible fracture may be performed with an anticipated return of functional and subjective neurosensory recovery within 3 months of surgery.
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Affiliation(s)
- Joseph E Cillo
- Associate Professor, Division Chair, Residency Program Director, and Director of Research, Division of Oral and Maxillofacial Surgery, Pittsburgh, PA.
| | - Scott Godwin
- Formerly, Chief Resident, Currently, Private Practice, Division of Oral and Maxillofacial Surgery, Pittsburgh, PA
| | - Erica Becker
- Formerly, Chief Resident, Currently, Private Practice, Division of Oral and Maxillofacial Surgery, Pittsburgh, PA
| | - Rebecca Schorr
- Senior Research Statistician, Data Science R&D, Highmark Health, Pittsburgh, PA
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Masgoret P, de Soto I, Caballero Á, Ríos J, Gomar C. Incidence of contralateral neurosensitive changes and persistent postoperative pain 6 months after mastectomy: A prospective, observational investigation. Medicine (Baltimore) 2020; 99:e19101. [PMID: 32176037 PMCID: PMC7440329 DOI: 10.1097/md.0000000000019101] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Mirror image sensory dysfunction (MISD) after breast surgery has not yet been studied. This prospective observational study aimed to determine the incidence of MISD, persistent postoperative pain (PPP) and mirror image pain (MIP) during 6 months after total unilateral mastectomy.Visual analogue scale (VAS), Neuropathic Pain Symptom Inventory (NPSI), Pain Catastrophizing Scale (PCS), Hospital Anxiety and Depression Scale (HADS), Life orientation test (LOT) and Quantitative Sensory Testing (QST) (in ipsi and contralateral breast, axilla and thigh) were recorded. VAS > 3 at 1, 3, and 6 postoperative months was considered PPP. Contralateral changes of QST at any time was considered indicative of MISD and spontaneous contralateral VAS ≥ 1 as MIP.Sixty-four patients were included. PPP at 1, 3 and 6 months was 18.8%, 56.2%, and 21.3%, respectively Ten patients presented MIP. MISD was detected in 79.7% patients in contralateral breast and 62.5% in contralateral axilla. Furthermore, changes in QST were present in 39.1% of patients in thigh. Electronic Von Frey (EVF) changes in both contralateral breast and axilla, and in thigh significantly diminished at all postoperative times. Changes of postoperative EVF ≥ 20% in contralateral breast were associated to higher VAS values. NPSI scores were significantly higher at all postoperative times. At 1 month, PCS, depression HADS subscale and LOT scores were significantly worse than all the other periods.MISD incidence was almost 80%, and 15.6% of patients showed spontaneous contralateral VAS ≥ 1. At 6 months 21.3% of patients manifested PPP. The worst alteration of factors related to PPP occurred at 1 postoperative month. Most consistent QST was EVF.
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Affiliation(s)
- Paula Masgoret
- Department of Anesthesiology, Hospital Clinic, University of Barcelona
| | - Inés de Soto
- Department of Anesthesiology, Consorci Sanitari Parc Taulí de Sabadell
| | - Ángel Caballero
- Department of Anesthesiology, Hospital Clinic, University of Barcelona
| | - José Ríos
- Laboratory of Biostatistics and Epidemiology, Universitat Autonoma de Barcelona, Biostatistics and Data Management Platform, IDIBAPS, Hospital Clinic, Barcelona, Spain
| | - Carmen Gomar
- Department of Anesthesiology, Hospital Clinic, University of Barcelona
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The Effect of Topical Anaesthesia on the Cortisol Responses of Calves Undergoing Dehorning. Animals (Basel) 2020; 10:ani10020312. [PMID: 32079225 PMCID: PMC7070772 DOI: 10.3390/ani10020312] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Accepted: 02/10/2020] [Indexed: 11/17/2022] Open
Abstract
Simple Summary Dehorning in cattle involves the manual removal of horns which causes acute pain. Although the long-term solution to removing horns is to breed polled cattle, limitations include the complex inheritance for polled Brahman cattle, and negative interactions with productivity in dairy cattle. Best practice pain relief in the form of a local nerve block, a sedative and a non-steroidal anti-inflammatory drug prior to the procedure usually requires a veterinarian and may be impractical for some cattle production systems. Improved livestock welfare requires a practical and cost-effective pain relief strategy for dehorning that can be readily adopted commercially. We evaluated a modified topical local anaesthetic wound formulation that can be applied by farmers immediately following dehorning. While previous studies have demonstrated a reduction in wound sensitivity, there was no effect on cortisol concentrations. It is likely that the cortisol response reflects a combination of factors including the stress of handling, the initial pain of the dehorning procedure and haemorrhage. Abstract Dehorning causes pain and distress to cattle, and there is a need to provide effective and practical analgesia to improve animal welfare. We conducted an experiment to determine the effect of a modified post-operative topical wound management formulation containing two local anaesthetics (TA) on the plasma cortisol concentration (PCC) of scoop-dehorned calves. Two months old Holstein-Friesian heifer calves (n = 30) were randomly allocated to sham dehorning control (CON), scoop dehorning (D), or scoop dehorning with immediate post-operative application of the TA (DTA). Blood samples were obtained via jugular venepuncture prior to sham or actual dehorning, and 40 min, 1.5, 4 and 24 h later. PCC changed significantly over time (p < 0.01). There was a trend for lower PCC in DTA calves compared to D calves (p = 0.09), with the PCC area under the curve lowest in CON calves as compared to D and DTA calves (p = 0.02). Cortisol concentrations were similar between D and DTA at all time points. The TA did not reduce cortisol concentrations up to 24 h following treatment and the cortisol response likely reflects the pain induced by the procedure, the effect of handling and restraint, and haemorrhaging which limited adherence of the TA actives. A multimodal analgesic approach, as assessed through multiple pain indicators, should be the focus of future work.
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Farrell AT, Panepinto J, Carroll CP, Darbari DS, Desai AA, King AA, Adams RJ, Barber TD, Brandow AM, DeBaun MR, Donahue MJ, Gupta K, Hankins JS, Kameka M, Kirkham FJ, Luksenburg H, Miller S, Oneal PA, Rees DC, Setse R, Sheehan VA, Strouse J, Stucky CL, Werner EM, Wood JC, Zempsky WT. End points for sickle cell disease clinical trials: patient-reported outcomes, pain, and the brain. Blood Adv 2019; 3:3982-4001. [PMID: 31809538 PMCID: PMC6963237 DOI: 10.1182/bloodadvances.2019000882] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 09/26/2019] [Indexed: 12/12/2022] Open
Abstract
To address the global burden of sickle cell disease (SCD) and the need for novel therapies, the American Society of Hematology partnered with the US Food and Drug Administration to engage the work of 7 panels of clinicians, investigators, and patients to develop consensus recommendations for clinical trial end points. The panels conducted their work through literature reviews, assessment of available evidence, and expert judgment focusing on end points related to: patient-reported outcomes (PROs), pain (non-PROs), the brain, end-organ considerations, biomarkers, measurement of cure, and low-resource settings. This article presents the findings and recommendations of the PROs, pain, and brain panels, as well as relevant findings and recommendations from the biomarkers panel. The panels identify end points, where there were supporting data, to use in clinical trials of SCD. In addition, the panels discuss where further research is needed to support the development and validation of additional clinical trial end points.
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Affiliation(s)
| | - Julie Panepinto
- Pediatric Hematology, Medical College of Wisconsin/Children's Wisconsin, Milwaukee, WI
| | - C Patrick Carroll
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD
| | | | - Ankit A Desai
- Krannert Institute of Cardiology, Indiana University, Bloomington, IN
| | - Allison A King
- Division of Hematology and Oncology in Pediatrics and Medicine, Washington University School of Medicine, St. Louis, MO
| | - Robert J Adams
- Department of Neurology, Medical University of South Carolina, Charleston, SC
| | | | - Amanda M Brandow
- Pediatric Hematology, Medical College of Wisconsin/Children's Wisconsin, Milwaukee, WI
| | - Michael R DeBaun
- Vanderbilt-Meharry Center of Excellence in Sickle Cell Disease, Vanderbilt University Medical Center, Nashville, TN
| | - Manus J Donahue
- Department of Radiology and Radiological Sciences
- Department of Neurology, and
- Department of Psychiatry, School of Medicine, Vanderbilt University, Nashville, TN
| | - Kalpna Gupta
- Division of Hematology, Oncology, and Transplantation, Department of Medicine, Medical School, University of Minnesota, Minneapolis, MN
| | - Jane S Hankins
- Department of Hematology, St. Jude Children's Research Hospital, Memphis, TN
| | - Michelle Kameka
- Nicole Wertheim College of Nursing and Health Sciences, Florida International University, Miami, FL
| | - Fenella J Kirkham
- Developmental Neurosciences Unit and
- Biomedical Research Unit, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Harvey Luksenburg
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | | | | | - David C Rees
- Department of Haematological Medicine, King's College Hospital, London, United Kingdom
- School of Cancer and Pharmaceutical Sciences, King's College London, London, United Kingdom
| | | | - Vivien A Sheehan
- Division of Hematology/Oncology, Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | - John Strouse
- Division of Hematology, Department of Medicine, and
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Duke University School of Medicine, Durham, NC
| | - Cheryl L Stucky
- Department of Cell Biology, Neurobiology, and Anatomy, Medical College of Wisconsin, Milwaukee, WI
| | - Ellen M Werner
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | - John C Wood
- Children's Hospital Los Angeles, Los Angeles, CA; and
| | - William T Zempsky
- Department of Pediatrics, Connecticut Children's/School of Medicine, University of Connecticut, Hartford, CT
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Li S, Chai XN, Zuo CY, Lv P, Tang Y, Tan HJ, Liu LZ, Yin HY, Yu SG. Metabolic profiling of dialysate at sensitized acupoints in knee osteoarthritis patients: A study protocol. Medicine (Baltimore) 2019; 98:e17843. [PMID: 31702640 PMCID: PMC6855587 DOI: 10.1097/md.0000000000017843] [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] [Received: 10/09/2019] [Accepted: 10/10/2019] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Acupuncture therapy is frequently used to treat Knee Osteoarthritis (KOA) in clinic, and usually used local acupoints near the diseased knees as therapeutic targets. Some local acupoints appeared sensitization phenomenon which was called sensitized acupoints, which were regarded as important therapeutic targets to get better therapeutic effect on clinic. Therefore, it is necessary to explore the biological basis of acupoint sensitization. Meanwhile, there is a lack of an analysis of the metabolism for sensitized acupoints in KOA patients. Considering that acupuncture effect could be multi-targeted, omics (such as metabolomics) may be a useful method to reveal the relationship between sensitized acupoints and clinical efficacy of acupuncture. METHODS AND ANALYSIS This study is a parallel design trial. Thirty KOA patients and 30 healthy volunteers will be recruited in this study. Mechanical pain threshold will be measured by Electron Von frey in order to confirm the highest sensitized acupoints. Then collect tissue fluid from the highest sensitized acupoints by micro dialysis technical, then apply electro-acupuncture method on the highest sensitized acupoints to treat KOA patients, after 20 sessions treatments, measure and collect again. Liquid chromatography-tandem mass spectrometry method will be used to analyze the metabonomics of dialysate. RESULTS This study will provide a high-quality evidence to reveal the local molecular mechanism of acupuncture sensitized acupoints for patient with KOA. CONCLUSION This study will provide up-date evidence of whether acupuncture sensitized acupoints have local molecular mechanism for KOA. TRIAL REGISTRATION NUMBER NCT03599180 (24 Jul. 2018).
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Affiliation(s)
- Sheng Li
- Chengdu University of Traditional Chinese Medicine, Chengdu
- Southwest Medical University, Luzhou, China
| | - Xiao Ning Chai
- Chengdu University of Traditional Chinese Medicine, Chengdu
| | - Chuan Yi Zuo
- Chengdu University of Traditional Chinese Medicine, Chengdu
| | - Peng Lv
- Chengdu University of Traditional Chinese Medicine, Chengdu
| | - Yong Tang
- Chengdu University of Traditional Chinese Medicine, Chengdu
| | - Hui Juan Tan
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Li Zhou Liu
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Hai Yan Yin
- Chengdu University of Traditional Chinese Medicine, Chengdu
| | - Shu Guang Yu
- Chengdu University of Traditional Chinese Medicine, Chengdu
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Ezenwa MO, Yao Y, Nguyen MNT, Mandernach MW, Hunter CT, Yoon SL, Fedele D, Lucero RJ, Lyon D, Wilkie DJ. Randomized Pilot Study: A Mobile Technology-based Self-management Intervention for Sickle Cell Pain. West J Nurs Res 2019; 42:629-639. [PMID: 31583977 DOI: 10.1177/0193945919878821] [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: 11/16/2022]
Abstract
Little is known about the effects of self-managed relaxation interventions on pain, stress, and autonomic responses in patients with sickle cell disease (SCD). This pre-post randomized controlled pilot study was conducted to determine the feasibility of using computer tablets for relaxation intervention delivery; acceptability of study procedures; and intervention effects on pain, stress, and indicators of relaxation. The 30 research participants ranged in age from 22 years to 59 years. All were African American; 53% were male. They were randomized to an experimental group that watched a relaxation video or a control group that discussed their disease. All participants completed the study, indicating feasibility. Acceptability rates were also high. Data were obtained for the intervention's immediate effect on pain, stress, respiration, pulse, finger skin temperature, and self-reported relaxation. These preliminary findings will guide future, higher-powered studies to determine the intervention's efficacy and mechanism in SCD.The ClinicalTrials.gov Identifier: NCT02729363.
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Affiliation(s)
- Miriam O Ezenwa
- Department of Biobehavioral Nursing Science, College Of Nursing, University of Florida, Gainesville, Florida, USA
| | - Yingwei Yao
- Department of Biobehavioral Nursing Science, College Of Nursing, University of Florida, Gainesville, Florida, USA
| | - Minh-Nguyet T Nguyen
- Department of Medicine, Division of Hematology/Oncology, University of Florida, Gainesville, Florida, USA
| | - Molly W Mandernach
- Department of Medicine, Division of Hematology/Oncology, University of Florida, Gainesville, Florida, USA
| | - Clayton T Hunter
- Department of Medicine, Division of Hematology/Oncology, University of Florida, Gainesville, Florida, USA
| | - Saunjoo L Yoon
- Department of Biobehavioral Nursing Science, College Of Nursing, University of Florida, Gainesville, Florida, USA
| | - David Fedele
- Department of Clinical & Health Psychology, Gainesville, Florida, USA
| | - Robert J Lucero
- Department of Family, Community, and Health System Science, College Of Nursing, University of Florida, Gainesville, Florida, USA
| | - Debra Lyon
- Department of Biobehavioral Nursing Science, College Of Nursing, University of Florida, Gainesville, Florida, USA
| | - Diana J Wilkie
- Department of Biobehavioral Nursing Science, College Of Nursing, University of Florida, Gainesville, Florida, USA
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Children and adolescents with sickle cell disease have worse cold and mechanical hypersensitivity during acute painful events. Pain 2019; 160:407-416. [PMID: 30247266 DOI: 10.1097/j.pain.0000000000001407] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Sickle cell disease (SCD) pain associates with cold temperature and touch. Patients and murine models with SCD have baseline thermal and mechanical pain. In SCD mice, the baseline hypersensitivity is exacerbated by experimental vaso-occlusive crises. We hypothesized that patients with SCD will similarly experience increased hypersensitivity to thermal and mechanical stimuli during acute painful events compared with baseline health. We conducted a prospective study of 24 patients with SCD aged 7 to 19 years. Patients underwent quantitative sensory testing to thermal (cold/heat) and mechanical stimuli on the thenar eminence of the nondominant hand (glabrous skin) and the lateral dorsum of the foot (hairy skin) during baseline health and within 48 hours of hospitalization for acute pain. Primary outcomes were changes in: (1) cold pain threshold (°C), (2) heat pain threshold (°C), and (3) mechanical pain threshold (g). Median age was 10.5 (interquartile range [IQR] 9-14.8) years, 67% were females, and 92% were on hydroxyurea. Patients with SCD had increased cold pain sensitivity in the hand during hospitalization compared with baseline (25.2°C [IQR 18.4-27.5°C] vs 21.3°C [IQR 4.9-26.2°C]; P = 0.011) and increased mechanical pain sensitivity in the foot during hospitalization (0.32 g [IQR 0.09-1.1 g] vs 1.7 g [IQR 0.4-8.3 g]; P = 0.003). There were no differences in heat pain sensitivity. The increased cold (P = 0.02) and mechanical (P = 0.0016) pain sensitivity during hospitalization persisted after adjusting for age, sex, hydroxyurea use, opioid consumption, and numeric pain score. Thus, cold and mechanical pain is significantly worse during an acute SCD painful event as compared to baseline health in patients with SCD.
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Abstract
OBJECTIVE Cannabis (marijuana) is undergoing extensive regulatory review in many global jurisdictions for medical and nonmedical access. Cannabis has potential impact on the health of athletes as well as on performance in both training and in competition. The aim of this general review is to identify and highlight the challenges in interpreting information with respect to elite athletic performance, and to point to important research areas that need to be addressed. DATA SOURCES A nonsystematic literature review was conducted using Medline and PubMed for articles related to cannabis/marijuana use and sports/athletic performance; abstracts were reviewed by lead author and key themes identified and explored. MAIN RESULTS Cannabis may be primarily inhaled or ingested orally for a range of medical and nonmedical reasons; evidence for efficacy is limited but promising for chronic pain management. Although evidence for serious harms from cannabis use on health of athletes is limited, one should be cognizant of the potential for abuse and mental health issues. Although the prevalence of cannabis use among elite athletes is not well-known, use is associated with certain high-risk sports. There is no evidence for cannabis use as a performance-enhancing drug. CONCLUSIONS Medical and nonmedical cannabis use among athletes reflects changing societal and cultural norms and experiences. Although cannabis use is more prevalent in some athletes engaged in high-risk sports, there is no direct evidence of performance-enhancing effects in athletes. The potential beneficial effects of cannabis as part of a pain management protocol, including reducing concussion-related symptoms, deserve further attention.
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Mirra A, Spadavecchia C, Bruckmaier R, Gutzwiller A, Casoni D. Acute pain and peripheral sensitization following cautery disbudding in 1- and 4-week-old calves. Physiol Behav 2017; 184:248-260. [PMID: 29221809 DOI: 10.1016/j.physbeh.2017.11.031] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Revised: 11/30/2017] [Accepted: 11/30/2017] [Indexed: 12/25/2022]
Abstract
Acute pain and peripheral sensitization development after cautery disbudding was investigated in 33 calves administered preventive multimodal analgesia. The animals were assigned randomly to three groups: 1) Group SH (Control), undergoing sham disbudding at 1 and 4weeks of age; 2) Group ED (Early Disbudding), undergoing disbudding at 1week of age and sham disbudding at 4weeks of age; 3) Group LD (Late Disbudding), undergoing sham disbudding at 1week of age and disbudding at 4weeks of age. Physiological parameters (heart rate, respiratory rate, rectal temperature, invasive blood pressure, cortisol, β-endorphin, interleukin-1β, interleukin-6, tumor necrosis factor-α and haptoglobin plasmatic concentration), local variables (tactile sensitivity score, pressure pain thresholds and horn temperature), behavior and pain scores [multidimensional pain scale and visual analogue scale (VAS)] were assessed at baseline and at several pre-determined time points until 24h after disbudding. Tactile sensitivity score significantly and equally increased in both groups ED and LD and pressure pain thresholds significantly decreased in group LD until 24h after disbudding compared to group SH. Pain and VAS scores significantly and equally increased in both groups ED and LD until 24h after disbudding compared to group SH. No significant differences in physiological parameters, behavior and horn temperature were detected among groups. The present study suggests that acute pain and peripheral sensitization develop and do not differ in calves disbudded at 1week and 4weeks of age. Moreover, the use of physiological and behavioral parameters as sole indicators of acute pain might lead to improper conclusions and should be reassessed.
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Affiliation(s)
- Alessandro Mirra
- Department of Clinical Veterinary Medicine, Anaesthesiology and Pain Therapy Section, Vetsuisse Faculty, University of Bern, Länggassstrasse 124, 3012 Bern, Switzerland.
| | - Claudia Spadavecchia
- Department of Clinical Veterinary Medicine, Anaesthesiology and Pain Therapy Section, Vetsuisse Faculty, University of Bern, Länggassstrasse 124, 3012 Bern, Switzerland.
| | - Rupert Bruckmaier
- Veterinary Physiology, Vetsuisse Faculty, University of Bern, Bremgartenstrasse 109a, 3012 Bern, Switzerland.
| | | | - Daniela Casoni
- Department of Clinical Veterinary Medicine, Anaesthesiology and Pain Therapy Section, Vetsuisse Faculty, University of Bern, Länggassstrasse 124, 3012 Bern, Switzerland.
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Zhao W, Wang Y, Fang Q, Wu J, Gao X, Liu H, Cao L, An J. Changes in neurotrophic and inflammatory factors in the cerebrospinal fluid of patients with postherpetic neuralgia. Neurosci Lett 2017; 637:108-113. [DOI: 10.1016/j.neulet.2016.11.041] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 11/18/2016] [Accepted: 11/20/2016] [Indexed: 12/22/2022]
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11
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Ochiai W, Kaneta M, Nagae M, yuzuhara A, Li X, Suzuki H, Hanagata M, Kitaoka S, Suto W, Kusunoki Y, Kon R, Miyashita K, Masukawa D, Ikarashi N, Narita M, Suzuki T, Sugiyama K. Mice with neuropathic pain exhibit morphine tolerance due to a decrease in the morphine concentration in the brain. Eur J Pharm Sci 2016; 92:298-304. [DOI: 10.1016/j.ejps.2016.03.019] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Revised: 03/05/2016] [Accepted: 03/22/2016] [Indexed: 11/29/2022]
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12
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Ezenwa MO, Yao Y, Engeland CG, Molokie RE, Wang ZJ, Suarez ML, Wilkie DJ. A randomized controlled pilot study feasibility of a tablet-based guided audio-visual relaxation intervention for reducing stress and pain in adults with sickle cell disease. J Adv Nurs 2016; 72:1452-63. [PMID: 26768753 DOI: 10.1111/jan.12895] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/19/2015] [Indexed: 01/09/2023]
Abstract
AIM To test feasibility of a guided audio-visual relaxation intervention protocol for reducing stress and pain in adults with sickle cell disease. BACKGROUND Sickle cell pain is inadequately controlled using opioids, necessitating further intervention such as guided relaxation to reduce stress and pain. DESIGN Attention-control, randomized clinical feasibility pilot study with repeated measures. METHODS Randomized to guided relaxation or control groups, all patients recruited between 2013-2014 during clinical visits, completed stress and pain measures via a Galaxy Internet-enabled Android tablet at the Baseline visit (pre/post intervention), 2-week posttest visit and also daily at home between the two visits. Experimental group patients were asked to use a guided relaxation intervention at the Baseline visit and at least once daily for 2 weeks. Control group patients engaged in a recorded sickle cell discussion at the Baseline visit. Data were analysed using linear regression with bootstrapping. RESULTS At baseline, 27/28 of consented patients completed the study protocol. Group comparison showed that guided relaxation significantly reduced current stress and pain. At the 2-week posttest, 24/27 of patients completed the study, all of whom reported liking the study. Patients completed tablet-based measures on 71% of study days (69% in control group, 72% in experiment group). At the 2-week posttest, the experimental group had significantly lower composite pain index scores, but the two groups did not differ significantly on stress intensity. CONCLUSION This study protocol appears feasible. The tablet-based guided relaxation intervention shows promise for reducing sickle cell pain and warrants a larger efficacy trial. TRIAL REGISTRATION The ClinicalTrials.gov Identifier is: NCT02501447.
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Affiliation(s)
- Miriam O Ezenwa
- Department of Biobehavioral Health Science, University of Illinois at Chicago, College of Nursing, Illinois, USA.,Comprehensive Sickle Cell Center, University of Illinois at Chicago, College of Nursing, Illinois, USA
| | - Yingwei Yao
- Department of Biobehavioral Health Science, University of Illinois at Chicago, College of Nursing, Illinois, USA
| | - Christopher G Engeland
- Department of Biobehavioral Health, College of Nursing, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - Robert E Molokie
- College of Medicine, College of Pharmacy and Comprehensive Sickle Cell Center, University of Illinois at Chicago, Chicago, Illinois, USA.,Jesse Brown VA Medical Center, Chicago, Illinois, USA
| | - Zaijie Jim Wang
- Department of Biopharmaceutical Sciences, Cancer Center, and Comprehensive Sickle Cell Center, University of Illinois at Chicago, College of Pharmacy, Illinois, USA
| | - Marie L Suarez
- Department of Biobehavioral Health Science, University of Illinois at Chicago, College of Nursing, Illinois, USA
| | - Diana J Wilkie
- Center for End-of-Life Transition Research, Department of Biobehavioral Health Science, University of Illinois at Chicago, College of Nursing, Illinois, USA.,Cancer Center and Comprehensive Sickle Cell Center, University of Illinois at Chicago, College of Nursing, Illinois, USA
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Abstract
BACKGROUND The assessment of any patient or examinee with neurological impairment, whether acquired or congenital, provides a key set of data points in the context of developing accurate diagnostic impressions and implementing an appropriate neurorehabilitation program. As part of that assessment, the neurological physical exam is an extremely important component of the overall neurological assessment. PURPOSE In the aforementioned context, clinicians often are confounded by unusual, atypical or unexplainable physical exam findings that bring into question the organicity, veracity, and/or underlying cause of the observed clinical presentation. The purpose of this review is to provide readers with general directions and specific caveats regarding validity assessment in the context of the neurological physical exam. CONCLUSIONS It is of utmost importance for health care practitioners to be aware of assessment methodologies that may assist in determining the validity of the neurological physical exam and differentiating organic from non-organic/functional impairments. Maybe more importantly, the limitations of many commonly used strategies for assessment of non-organicity should be recognized and consider prior to labeling observed physical findings on neurological exam as non-organic or functional.
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Affiliation(s)
- Nathan D Zasler
- Concussion Care Centre of Virginia, Ltd, Richmond, VA, USA.,Tree of Life Services, Inc, Richmond, VA, USA.,VCU Department of Physical Medicine and Rehabilitation, Richmond, VA, USA.,Department of Physical Medicine and Rehabilitation, University of Virginia, Charlottesville, VA, USA.,University of Virginia Brain Injury and Sports Concussion Institute, Charlottesville, VA, USA.,Distinguished Clinical Professor of Health Sciences, School of Health Sciences, Touro College, NY, USA
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Espinoza C, Lomax S, Windsor P. The effect of a topical anesthetic on the sensitivity of calf dehorning wounds. J Dairy Sci 2013; 96:2894-902. [PMID: 23477817 DOI: 10.3168/jds.2012-5954] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2012] [Accepted: 01/09/2013] [Indexed: 11/19/2022]
Abstract
The objective was to determine the effect of a topical local anesthetic on the sensitivity of dehorning wounds in calves. Thirty 2-mo-old Holstein-Friesian calves were randomly allocated to sham dehorning control (CON), scoop dehorning without treatment with topical anesthetic (SnoTA), or scoop dehorning with an application of a topical anesthetic (STA). Sensitivity was measured by providing mechanical stimulation to the dehorned wound and peri-wound area using von Frey monofilaments calibrated at 10 and 300 g. Calf responses were categorized as absent, minor, moderate, or severe. Sensitivity measurements were performed before treatment and at various time points up to 24h posttreatment. Sham dehorned calves displayed unchanging absent or minor responses to stimulation. Regardless of whether topical anesthetic was applied, scoop dehorned calves were more likely to display minor, moderate, or severe responses than sham dehorned control calves, and responses tended to be most extreme at 4h postdehorning. Calves in the STA group tended to be less likely to display minor, moderate, or severe responses than calves in the SnoTA group at most time points (exception at 4h postdehorning). Responses were significantly more likely to be less severe in STA calves than in SnoTA calves at 40 min and 1.5h following dehorning. Thus, the use of the topical anesthetic for calves reduced the short-term sensitivity of scoop dehorning wounds.
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Affiliation(s)
- C Espinoza
- The University of Sydney, Private Bag 4003 Narellan, New South Wales 2567, Australia
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Clinical assessments of increased sensory sensitivity in dogs with cranial cruciate ligament rupture. Vet J 2012; 193:545-50. [DOI: 10.1016/j.tvjl.2012.01.019] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2011] [Revised: 01/11/2012] [Accepted: 01/18/2012] [Indexed: 01/04/2023]
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Comparison of manual and automated filaments for evaluation of neuropathic pain behavior in rats. J Pharmacol Toxicol Methods 2012; 66:8-13. [DOI: 10.1016/j.vascn.2012.04.006] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2011] [Revised: 04/12/2012] [Accepted: 04/13/2012] [Indexed: 11/21/2022]
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Bar-Shalita T, Vatine JJ, Parush S, Deutsch L, Seltzer Z. Psychophysical correlates in adults with sensory modulation disorder. Disabil Rehabil 2011; 34:943-50. [PMID: 22149534 DOI: 10.3109/09638288.2011.629711] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE Individuals with sensory modulation disorder (SMD) demonstrate abnormal responses to naturally occurring stimuli in a manner that interferes with daily life activities. This study is the first study applying quantitative sensory testing to characterize the somatosensory sensitivity of adults with SMD. METHOD One hundred and fifty one adults (68 males and 83 females) were tested comparing 91 SMD to 60 SMD-free, control individuals. Group placement (SMD vs. SMD-free) was determined using the Sensory Responsiveness Questionnaire (SRQ). Sensory detection thresholds for skin warming, cooling, punctate dynamic tactile sensation, vibration and thermal pain thresholds for heat and cold stimuli were determined at several body sites. Pinprick pain and prickliness were also assessed, as well as the duration and intensity of the after-sensations of prickliness and pain evoked by the prickly stimuli. RESULTS Compared to control adults, individuals with SMD showed significantly higher pain intensity to prickle stimuli, marginally higher pain intensity to pinprick and hypoesthesia to punctate dynamic tactile sensation at one of two sites tested. CONCLUSIONS These results are in line with our previous study that investigated children with SMD using the same stimuli, and found similar results. We suggest a CNS involvement as the underlying mechanisms in SMD.
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Affiliation(s)
- Tami Bar-Shalita
- School of Occupational Therapy, Faculty of Medicine of Hadassah and the Hebrew University of Jerusalem, Jerusalem, Israel
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van Wilgen CP, Keizer D. Neuropathic Pain Mechanisms in Patients with Chronic Sports Injuries: A Diagnostic Model Useful in Sports Medicine? PAIN MEDICINE 2011; 12:110-7. [DOI: 10.1111/j.1526-4637.2010.01023.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Spinal cord injuries containing asymmetrical damage in the ventrolateral funiculus is associated with a higher incidence of at-level allodynia. THE JOURNAL OF PAIN 2010; 11:864-75. [PMID: 20338826 DOI: 10.1016/j.jpain.2009.12.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2009] [Revised: 10/09/2009] [Accepted: 12/10/2009] [Indexed: 01/13/2023]
Abstract
UNLABELLED Approximately 70% of male rats receiving severe T8 spinal contusions develop allodynia in T5-7 dermatomes (at-level) beginning 2 weeks after injury. In contrast, rats having either complete transections or dorsal hemisections do not develop allodynia at-level after chronic spinal cord injury (SCI). In the present study, incomplete laceration and contusion injuries were made to test for neuroanatomical correlates between areas of white matter damage/sparing at the lesion epicenter and the presence/absence of allodynia. After incomplete laceration lesions and 6 weeks of behavioral testing, histological reconstruction and analysis of the lesion epicenters revealed a significant difference (P < .001) in the amount of ventrolateral funiculus (VLF) asymmetry between rats showing pain-like responses evoked by touch (74.5% +/- 8.4% side-to-side difference in VLF damage) versus those not responding to touch (11.3% +/- 4.4% side-to-side difference in VLF damage). A 5-week mean allodynia score for each rat that incorporates a full range of forces that are all innocuous in intact controls revealed that the degree of hypersensitivity at level is related to the extent of VLF asymmetry after SCI. No other damaged spinal white matter or gray matter area was correlated with sensitivity to touch. Similar findings were obtained for rats receiving T8 contusions, a more clinically relevant injury. These data suggest that different extents of damage/sparing between the 2 sides of VLF probably are a requisite for the development of allodynia after SCI. PERSPECTIVE A side-to-side lesion asymmetry after chronic SCI in a rodent model was found to be highly correlated with the presence and degree of allodynia. Greater insight of key factors contributing to the development and maintenance of chronic neuropathic pain is important for improving quality of life.
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Bar-Shalita T, Vatine JJ, Seltzer Z, Parush S. Psychophysical correlates in children with sensory modulation disorder (SMD). Physiol Behav 2009; 98:631-9. [DOI: 10.1016/j.physbeh.2009.09.020] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2009] [Revised: 09/17/2009] [Accepted: 09/25/2009] [Indexed: 11/29/2022]
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Abstract
Neuropathic pain and pain that has a predominant neuropathic component can be difficult to diagnose in primary care. Several screening questionnaires that incorporate patient symptoms and signs have been developed, and some are supplemented with simple bedside clinical tests for nerve dysfunction. These tools should enable a more rapid and confident diagnosis by the nonspecialist and the earlier start of appropriate treatment.
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Affiliation(s)
- Stephen May
- Department of Anaesthesia, Victoria InfirmaryLangside Road, Glasgow, G42 9TYUK
| | - Mick Serpell
- University Department of Anaesthesia30 Shelley Court, Gartnavel General Hospital, Glasgow, G12 0YNUK
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Current World Literature. Curr Opin Anaesthesiol 2008; 21:684-93. [DOI: 10.1097/aco.0b013e328312c01b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Perez J, Ribera MV. Managing neuropathic pain with Sativex: a review of its pros and cons. Expert Opin Pharmacother 2008; 9:1189-95. [PMID: 18422475 DOI: 10.1517/14656566.9.7.1189] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Although not new, the use of cannabis-based drugs for treating chronic pain patients is becoming a hot topic for pain physicians and other specialists due to the constant flow of medical information regarding this pharmacological therapy. Its indication is becoming more clearly targeted towards pain syndromes arising from nerve damage. The number of cases reported, clinical trials and reviews published on this subject exponentially increase year by year. A possible explanation for this may be the fact that neuropathic pain is a highly disabling symptom and, consequently, there is a demand from patients and health professionals for a definitive remedy to treat this pain. METHODS Parallel to the number of articles on the effectiveness, recent articles describing the tolerability of cannabis-based drugs along with a more accurate characterisation of its side-effect profile and/or lack of effectiveness have been published, and they are placing a cautious stop for a more precise prescription of these medications. CONCLUSION This article reviews the current knowledge on the use of Sativex for treating neuropathic pains of different origin, and analyses the balance between the advantages and drawbacks of this therapy.
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Affiliation(s)
- Jordi Perez
- Universitat de Barcelona, Department of Anaesthesiology, Pain Clinic, Hospital Clinic, Villarroel 170, 08036, Barcelona, Spain
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