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Hong JY, Park JS, Suh SW, Yang JH, Park SY, Kim BT. Transforaminal epidural steroid injections in cervical spinal disease with moderate to severe disability: Comparative study in patients with or without surgery. Medicine (Baltimore) 2020; 99:e19266. [PMID: 32049868 PMCID: PMC7035037 DOI: 10.1097/md.0000000000019266] [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
Despite many clinical trials on cervical epidural steroid injections, the indications for and long-standing outcomes of this treatment remain controversial. We evaluated the outcomes and indications for transforaminal cervical epidural steroid injection (TCESI) in patients with moderate to severe disability.We prospectively gathered data from patients with 1 or 2-level cervical degenerative disease (herniated disc, foraminal stenosis) with moderate to severe disability (3.5 < initial visual analog scale < 6.5, 15 < Neck Disability Index < 35) and greater than 12 weeks of pain, despite conservative treatment. Patients with persistent disability and those who desired surgical intervention underwent decompression surgery. The clinical and demographic characteristics were compared between groups.Of the 309 patients who underwent TCESI, 221 (72%) did not receive surgical treatment during the 1-year follow-up period. The remaining 88 patients (28%) underwent surgery at a mean of 4.1 months after initial TCESI. Patients who underwent injection alone showed a significant decrease in disability and pain that persisted until the 1-year follow-up visit (P < .05). In patients who underwent surgery, the mean disability and pain scores after injection did not decrease for several months, although the scores significantly decreased up to 1 year after surgery (P < .05).The TCESI significantly decreased pain and disability in the moderate to severe disability group up to 1 year after injection. We recommend cervical TCESI as an initial treatment with moderate to severe disability patients.
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Affiliation(s)
- Jae-Young Hong
- Department of Orthopedics, Korea University Ansan Hospital, Ansan
| | - Jin-Sung Park
- Department of Orthopedics, Korea University Ansan Hospital, Ansan
| | - Seung-Woo Suh
- Department of Orthopedics, Korea University Guro Hospital
| | - Jae-Hyuk Yang
- Department of Orthopedics, Korea University Guro Hospital
| | - Si-Young Park
- Department of Orthopedics, Korea University Anam Hospital, Seoul, South Korea
| | - Bo Taek Kim
- Department of Orthopedics, Korea University Ansan Hospital, Ansan
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Dower A, Davies MA, Ghahreman A. Pathologic Basis of Lumbar Radicular Pain. World Neurosurg 2019; 128:114-121. [DOI: 10.1016/j.wneu.2019.04.147] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Accepted: 04/16/2019] [Indexed: 12/26/2022]
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Hong J, Liu J, Zhang CH, Huang QF, Wu LX, Huang Y. Acupuncture-moxibustion at Jiaji (EX-B 2) points for intervertebral disc herniation: A systematic review. JOURNAL OF ACUPUNCTURE AND TUINA SCIENCE 2015. [DOI: 10.1007/s11726-015-0856-4] [Citation(s) in RCA: 1] [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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ISSLS Prize winner: Increased innervation and sensory nervous system plasticity in a mouse model of low back pain due to intervertebral disc degeneration. Spine (Phila Pa 1976) 2014; 39:1345-54. [PMID: 24718079 DOI: 10.1097/brs.0000000000000334] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Immunohistochemical and behavioral study using the SPARC (secreted protein, acidic, rich in cysteine)-null mouse model of low back pain (LBP) associated with accelerated intervertebral disc (IVD) degeneration. OBJECTIVE To determine if behavioral signs of LBP in SPARC-null mice are accompanied by sensory nervous system plasticity. SUMMARY OF BACKGROUND DATA IVD pathology is a significant contributor to chronic LBP. In humans and rodents, decreased expression of SPARC is associated with IVD degeneration. We previously reported that SPARC-null mice exhibit age-dependent behavioral signs of chronic axial LBP and radiating leg pain. METHODS SPARC-null and age-matched control young, middle-aged, and old mice (1.5, 6, and 24 mo of age, respectively) were evaluated. Cutaneous hind paw sensitivity to cold, heat, and mechanical stimuli were evaluated as measures of radiating pain. The grip force and tail suspension assays were performed to evaluate axial LBP. Motor impairment was assessed using an accelerating rotarod. IVD innervation was identified by immunohistochemistry targeting the nerve fiber marker PGP9.5 and the sensory neuropeptide calcitonin gene-related peptide (CGRP). Sensory nervous system plasticity was evaluated by quantification of CGRP- and neuropeptide-Y-immunoreactivity (-ir) in dorsal root ganglia neurons and CGRP-ir, GFAP-ir (astrocyte marker), and Iba-1-ir (microglia marker) in the spinal cord. RESULTS SPARC-null mice developed hypersensitivity to cold, axial discomfort, age-dependent motor impairment, age-dependent increases in sensory innervation in and around the IVDs, age-dependent upregulation of CGRP and neuropeptide-Y in dorsal root ganglia, and age-dependent upregulation of CGRP, microglia, and astrocytes in the spinal cord dorsal horn. CONCLUSION Increased innervation of degenerating IVDs by sensory nerve fibers and the neuroplasticity in sensory neurons and spinal cord could contribute to the underlying pathobiology of chronic discogenic LBP. LEVEL OF EVIDENCE N/A.
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Nicholson KJ, Zhang S, Gilliland TM, Winkelstein BA. Riluzole effects on behavioral sensitivity and the development of axonal damage and spinal modifications that occur after painful nerve root compression. J Neurosurg Spine 2014; 20:751-62. [DOI: 10.3171/2014.2.spine13672] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
Cervical radiculopathy is often attributed to cervical nerve root injury, which induces extensive degeneration and reduced axonal flow in primary afferents. Riluzole inhibits neuro-excitotoxicity in animal models of neural injury. The authors undertook this study to evaluate the antinociceptive and neuroprotective properties of riluzole in a rat model of painful nerve root compression.
Methods
A single dose of riluzole (3 mg/kg) was administered intraperitoneally at Day 1 after a painful nerve root injury. Mechanical allodynia and thermal hyperalgesia were evaluated for 7 days after injury. At Day 7, the spinal cord at the C-7 level and the adjacent nerve roots were harvested from a subgroup of rats for immunohistochemical evaluation. Nerve roots were labeled for NF200, CGRP, and IB4 to assess the morphology of myelinated, peptidergic, and nonpeptidergic axons, respectively. Spinal cord sections were labeled for the neuropeptide CGRP and the glutamate transporter GLT-1 to evaluate their expression in the dorsal horn. In a separate group of rats, electrophysiological recordings were made in the dorsal horn. Evoked action potentials were identified by recording extracellular potentials while applying mechanical stimuli to the forepaw.
Results
Even though riluzole was administered after the onset of behavioral sensitivity at Day 1, its administration resulted in immediate resolution of mechanical allodynia and thermal hyperalgesia (p < 0.045), and these effects were maintained for the study duration. At Day 7, axons labeled for NF200, CGRP, and IB4 in the compressed roots of animals that received riluzole treatment exhibited fewer axonal swellings than those from untreated animals. Riluzole also mitigated changes in the spinal distribution of CGRP and GLT-1 expression that is induced by a painful root compression, returning the spinal expression of both to sham levels. Riluzole also reduced neuronal excitability in the dorsal horn that normally develops by Day 7. The frequency of neuronal firing significantly increased (p < 0.045) after painful root compression, but riluzole treatment maintained neuronal firing at sham levels.
Conclusions
These findings suggest that early administration of riluzole is sufficient to mitigate nerve root–mediated pain by preventing development of neuronal dysfunction in the nerve root and the spinal cord.
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Affiliation(s)
| | | | | | - Beth A. Winkelstein
- 1Departments of Bioengineering and
- 2Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania
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Zhang S, Nicholson KJ, Smith JR, Gilliland TM, Syré PP, Winkelstein BA. The roles of mechanical compression and chemical irritation in regulating spinal neuronal signaling in painful cervical nerve root injury. STAPP CAR CRASH JOURNAL 2013; 57:219-242. [PMID: 24435733 DOI: 10.4271/2013-22-0009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Both traumatic and slow-onset disc herniation can directly compress and/or chemically irritate cervical nerve roots, and both types of root injury elicit pain in animal models of radiculopathy. This study investigated the relative contributions of mechanical compression and chemical irritation of the nerve root to spinal regulation of neuronal activity using several outcomes. Modifications of two proteins known to regulate neurotransmission in the spinal cord, the neuropeptide calcitonin gene-related peptide (CGRP) and glutamate transporter 1 (GLT-1), were assessed in a rat model after painful cervical nerve root injuries using a mechanical compression, chemical irritation or their combination of injury. Only injuries with compression induced sustained behavioral hypersensitivity (p≤0.05) for two weeks and significant decreases (p<0.037) in CGRP and GLT-1 immunoreactivity to nearly half that of sham levels in the superficial dorsal horn. Because modification of spinal CGRP and GLT-1 is associated with enhanced excitatory signaling in the spinal cord, a second study evaluated the electrophysiological properties of neurons in the superficial and deeper dorsal horn at day 7 after a painful root compression. The evoked firing rate was significantly increased (p=0.045) after compression and only in the deeper lamina. The painful compression also induced a significant (p=0.002) shift in the percentage of neurons in the superficial lamina classified as low- threshold mechanoreceptive (sham 38%; compression 10%) to those classified as wide dynamic range neurons (sham 43%; compression 74%). Together, these studies highlight mechanical compression as a key modulator of spinal neuronal signaling in the context of radicular injury and pain.
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Affiliation(s)
- Sijia Zhang
- Department of Bioengineering, University of Pennsylvania
| | | | - Jenell R Smith
- Department of Bioengineering, University of Pennsylvania
| | | | - Peter P Syré
- Department of Neurosurgery, University of Pennsylvania
| | - Beth A Winkelstein
- Departments of Bioengineering and Neurosurgery, University of Pennsylvania
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Barbe MF, Gallagher S, Massicotte VS, Tytell M, Popoff SN, Barr-Gillespie AE. The interaction of force and repetition on musculoskeletal and neural tissue responses and sensorimotor behavior in a rat model of work-related musculoskeletal disorders. BMC Musculoskelet Disord 2013; 14:303. [PMID: 24156755 PMCID: PMC3924406 DOI: 10.1186/1471-2474-14-303] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Accepted: 10/22/2013] [Indexed: 12/01/2022] Open
Abstract
Background We examined the relationship of musculoskeletal risk factors underlying force and repetition on tissue responses in an operant rat model of repetitive reaching and pulling, and if force x repetition interactions were present, indicative of a fatigue failure process. We examined exposure-dependent changes in biochemical, morphological and sensorimotor responses occurring with repeated performance of a handle-pulling task for 12 weeks at one of four repetition and force levels: 1) low repetition with low force, 2) high repetition with low force, 3) low repetition with high force, and 4) high repetition with high force (HRHF). Methods Rats underwent initial training for 4–6 weeks, and then performed one of the tasks for 12 weeks, 2 hours/day, 3 days/week. Reflexive grip strength and sensitivity to touch were assayed as functional outcomes. Flexor digitorum muscles and tendons, forelimb bones, and serum were assayed using ELISA for indicators of inflammation, tissue stress and repair, and bone turnover. Histomorphometry was used to assay macrophage infiltration of tissues, spinal cord substance P changes, and tissue adaptative or degradative changes. MicroCT was used to assay bones for changes in bone quality. Results Several force x repetition interactions were observed for: muscle IL-1alpha and bone IL-1beta; serum TNFalpha, IL-1alpha, and IL-1beta; muscle HSP72, a tissue stress and repair protein; histomorphological evidence of tendon and cartilage degradation; serum biomarkers of bone degradation (CTXI) and bone formation (osteocalcin); and morphological evidence of bone adaptation versus resorption. In most cases, performance of the HRHF task induced the greatest tissue degenerative changes, while performance of moderate level tasks induced bone adaptation and a suggestion of muscle adaptation. Both high force tasks induced median nerve macrophage infiltration, spinal cord sensitization (increased substance P), grip strength declines and forepaw mechanical allodynia by task week 12. Conclusions Although not consistent in all tissues, we found several significant interactions between the critical musculoskeletal risk factors of force and repetition, consistent with a fatigue failure process in musculoskeletal tissues. Prolonged performance of HRHF tasks exhibited significantly increased risk for musculoskeletal disorders, while performance of moderate level tasks exhibited adaptation to task demands.
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Affiliation(s)
- Mary F Barbe
- Department of Anatomy and Cell Biology, Temple University School of Medicine, 3500 North Broad St, Philadelphia 19140, PA, USA.
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Dong L, Smith JR, Winkelstein BA. Ketorolac reduces spinal astrocytic activation and PAR1 expression associated with attenuation of pain after facet joint injury. J Neurotrauma 2013; 30:818-25. [PMID: 23126437 PMCID: PMC3660109 DOI: 10.1089/neu.2012.2600] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Chronic neck pain affects up to 70% of persons, with the facet joint being the most common source. Intra-articular injection of the non-steroidal anti-inflammatory drug ketorolac reduces post-operative joint-mediated pain; however, the mechanism of its attenuation of facet-mediated pain has not been evaluated. Protease-activated receptor-1 (PAR1) has differential roles in pain maintenance depending on the type and location of painful injury. This study investigated if the timing of intra-articular ketorolac injection after painful cervical facet injury affects behavioral hypersensitivity by modulating spinal astrocyte activation and/or PAR1 expression. Rats underwent a painful joint distraction and received an injection of ketorolac either immediately or 1 day later. Separate control groups included injured rats with a vehicle injection at day 1 and sham operated rats. Forepaw mechanical allodynia was measured for 7 days, and spinal cord tissue was immunolabeled for glial fibrillary acidic protein (GFAP) and PAR1 expression in the dorsal horn on day 7. Ketorolac administered on day 1 after injury significantly reduced allodynia (p=0.0006) to sham levels, whereas injection immediately after the injury had no effect compared with vehicle. Spinal astrocytic activation followed behavioral responses and was significantly decreased (p=0.009) only for ketorolac given at day 1. Spinal PAR1 (p=0.0025) and astrocytic PAR1 (p=0.012) were significantly increased after injury. Paralleling behavioral data, astrocytic PAR1 was returned to levels in sham only when ketorolac was administered on day 1. Yet, spinal PAR1 was significantly reduced (p<0.0001) by ketorolac independent of timing. Spinal astrocyte expression of PAR1 appears to be associated with the maintenance of facet-mediated pain.
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Affiliation(s)
- Ling Dong
- Department of Bioengineering, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jenell R. Smith
- Department of Bioengineering, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Beth A. Winkelstein
- Department of Bioengineering, University of Pennsylvania, Philadelphia, Pennsylvania
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania
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Yoganandan N, Stemper BD, Rao RD. Patient Mechanisms of Injury in Whiplash-Associated Disorders. ACTA ACUST UNITED AC 2013. [DOI: 10.1053/j.semss.2012.07.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Chew DJ, Murrell K, Carlstedt T, Shortland PJ. Segmental spinal root avulsion in the adult rat: a model to study avulsion injury pain. J Neurotrauma 2013; 30:160-72. [PMID: 22934818 DOI: 10.1089/neu.2012.2481] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Road traffic accidents are the most common cause of avulsion injury, in which spinal roots are torn from the spinal cord. Patients suffer from a loss of sensorimotor function, intractable spontaneous pain, and border-zone hypersensitivity. The neuropathic pains are particularly difficult to treat because the lack of a well-established animal model of avulsion injury prevents identifying the underlying mechanisms and hinders the development of efficacious drugs. This article describes a hindlimb model of avulsion injury in adult rats where the L5 dorsal and ventral spinal root are unilaterally avulsed (spinal root avulsion [SRA]), leaving the adjacent L4 spinal root intact. SRA produced a significant ipsilateral hypersensitivity to mechanical and thermal stimulation by 5 days compared with sham-operated or naïve rats. This hypersensitivity is maintained for up to 60 days. No autotomy was observed and locomotor deficits were minimal. The hypersensitivity to peripheral stimuli could be temporarily ameliorated by administration of amitriptyline and carbamazepine, drugs that are currently prescribed to avulsion patients. Histological assessment of the L4 ganglion cells revealed no significant alterations in calcitonin gene-related peptide (CGRP), IB4, transient receptor potential cation channel subfamily V member 1 (TrpV1), or N52 staining across groups. Immunohistochemistry of the spinal cord revealed a localized glial response, phagocyte infiltration, and neuronal loss within the ipsilateral avulsed segment. A comparable response from glia and phagocytes was also found in the intact L4 spinal cord, supporting the role for central mechanisms within the L4-5 spinal cord in contributing to the generation of the pain-related behavior. The SRA model provides a platform to investigate possible new pharmacological treatments for avulsion injuries.
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Affiliation(s)
- Daniel J Chew
- Centre for Neuroscience and Trauma, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, Newark Street, London, United Kingdom.
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Huang C, Zou W, Lee K, Wang E, Zhu X, Guo Q. Different symptoms of neuropathic pain can be induced by different degrees of compressive force on the C7 dorsal root of rats. Spine J 2012; 12:1154-60. [PMID: 23245939 DOI: 10.1016/j.spinee.2012.10.036] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2011] [Revised: 07/19/2012] [Accepted: 10/26/2012] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Neuropathic pain after nerve injuries is characterized by positive and negative sensory symptoms and signs. The extent of sensory fiber loss after nerve injuries has been demonstrated to correlate with symptoms of neuropathic pain by quantitative sensory testing and confirmed by biopsies of small nerve fibers. However, the relationship between the pathologic changes of large nerves on injuries and resulting pain symptoms remains unclear. PURPOSE To investigate the relationship between the extent of dorsal root injury and resulting symptoms of neuropathic pain. STUDY DESIGN Nerve injury and assessment of the following pain-related behaviors and neuropathologic changes. METHODS A total of 24 adult male Sprague-Dawley rats weighing 250 to 300 g were randomly divided into three groups (n=8 each): sham group operated on but without nerve compression, 70 gf group, and 180 gf group; a compression force of 70 or 180 g was applied to the right C7 dorsal root, separately. Threshold thermal and mechanical pains were measured before surgery (baseline) and on the first, third, fifth, and seventh day after surgery. On the seventh day after surgery, all rats were killed, and the structural alterations of nerve fibers within the compressed areas were examined. RESULTS A compression force of 70 g resulted in hyperalgesia, whereas a compression force of 180 g induced hypoalgesia in the ipsilateral forepaw in response to both mechanical and thermal stimulations within 7 days after injury. Light microscopy and electron microscopy revealed a mild to moderate sensory fiber loss after 70-gf compression and a more severe sensory fiber loss after 180-gf compression. CONCLUSIONS Transient injuries on sensory fibers can produce either positive or negative symptoms of neuropathic pain, and the different extent of sensory fiber loss after different degrees of injuries might account for the varied resulting symptoms of neuropathic pain.
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Affiliation(s)
- Changsheng Huang
- Department of Anesthesiology, Xiangya Hospital, Central South University, 87 Xiangya Rd, Changsha 410008, China
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Elliott MB, Oshinsky ML, Amenta PS, Awe OO, Jallo JI. Nociceptive neuropeptide increases and periorbital allodynia in a model of traumatic brain injury. Headache 2012; 52:966-84. [PMID: 22568499 DOI: 10.1111/j.1526-4610.2012.02160.x] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVE This study tests the hypothesis that injury to the somatosensory cortex is associated with periorbital allodynia and increases in nociceptive neuropeptides in the brainstem in a mouse model of controlled cortical impact (CCI) injury. METHODS Male C57BL/6 mice received either CCI or craniotomy-only followed by weekly periorbital von Frey (mechanical) sensory testing for up to 28 days post-injury. Mice receiving an incision only and naïve mice were included as control groups. Changes in calcitonin gene-related peptide (CGRP) and substance P (SP) within the brainstem were determined using enzyme-linked immunosorbent assay and immunohistochemistry, respectively. Activation of ionized calcium-binding adaptor molecule-1-labeled macrophages/microglia and glial fibrillary acidic protein (GFAP)-positive astrocytes were evaluated using immunohistochemistry because of their potential involvement in nociceptor sensitization. RESULTS Incision-only control mice showed no changes from baseline periorbital von Frey mechanical thresholds. CCI significantly reduced mean periorbital von Frey thresholds (periorbital allodynia) compared with baseline and craniotomy-only at each endpoint, analysis of variance P < .0001. Craniotomy significantly reduced periorbital threshold at 14 days but not 7, 21, or 28 days compared with baseline threshold, P < .01. CCI significantly increased SP immunoreactivity in the brainstem at 7 and 14 days but not 28 days compared with craniotomy-only and controls, P < .001. CGRP levels in brainstem tissues were significantly increased in CCI groups compared with controls (incision-only and naïve mice) or craniotomy-only mice at each endpoint examined, P < .0001. There was a significant correlation between CGRP and periorbital allodynia (P < .0001, r = -0.65) but not for SP (r = 0.20). CCI significantly increased the number of macrophage/microglia in the injured cortex at each endpoint up to 28 days, although cell numbers declined over weeks post-injury, P < .001. GFAP(+) immunoreactivity was significantly increased at 7 but not 14 or 28 days after CCI, P < .001. Craniotomy resulted in transient periorbital allodynia accompanied by transient increases in SP, CGRP, and GFAP immunoreactivity compared with control mice. There was no increase in the number of macrophage/microglia cells compared with controls after craniotomy. CONCLUSION Injury to the somatosensory cortex results in persistent periorbital allodynia and increases in brainstem nociceptive neuropeptides. Findings suggest that persistent allodynia and increased neuropeptides are maintained by mechanisms other than activation of macrophage/microglia or astrocyte in the injured somatosensory cortex.
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Affiliation(s)
- Melanie B Elliott
- Department of Neurological Surgery, Thomas Jefferson University, 1025 Walnut Street, Philadelphia, PA 19107, USA.
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Nicholson K, Guarino B, Winkelstein B. Transient nerve root compression load and duration differentially mediate behavioral sensitivity and associated spinal astrocyte activation and mGLuR5 expression. Neuroscience 2012; 209:187-95. [DOI: 10.1016/j.neuroscience.2012.02.027] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2011] [Revised: 01/27/2012] [Accepted: 02/15/2012] [Indexed: 01/12/2023]
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Abstract
STUDY DESIGN A nonsystematic review of the literature. OBJECTIVE The objective was to present general schema for mechanisms of whiplash pain and review the role of animal models in understanding the development of chronic pain from whiplash injury. SUMMARY OF BACKGROUND DATA Extensive biomechanical and clinical studies of whiplash have been performed to understand the injury mechanisms and symptoms of whiplash injury. However, only recently have animal models of this painful disorder been developed based on other pain models in the literature. METHODS A nonsystematic review was performed and findings were integrated to formulate a generalized picture of mechanisms by which chronic whiplash pain develops from mechanical tissue injuries. RESULTS The development of chronic pain from tissue injuries in the neck due to whiplash involves complex interactions between the injured tissue and spinal neuroimmune circuits. A variety of animal models are beginning to define these mechanisms. CONCLUSION Continued work is needed in developing appropriate animal models to investigate chronic pain from whiplash injuries and care must be taken to determine whether such models aim to model the injury event or the pain symptoms.
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Affiliation(s)
- Beth A Winkelstein
- Department of Bioengineering and Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA 19104-6321, USA.
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Chang YW, Winkelstein BA. Schwann Cell Proliferation and Macrophage Infiltration Are Evident at Day 14 after Painful Cervical Nerve Root Compression in the Rat. J Neurotrauma 2011; 28:2429-38. [DOI: 10.1089/neu.2011.1918] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Yu-Wen Chang
- Department of Bioengineering, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Beth A. Winkelstein
- Department of Bioengineering, University of Pennsylvania, Philadelphia, Pennsylvania
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania
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Dong L, Guarino BB, Jordan-Sciutto KL, Winkelstein BA. Activating transcription factor 4, a mediator of the integrated stress response, is increased in the dorsal root ganglia following painful facet joint distraction. Neuroscience 2011; 193:377-86. [PMID: 21821103 PMCID: PMC3171593 DOI: 10.1016/j.neuroscience.2011.07.059] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2011] [Revised: 07/01/2011] [Accepted: 07/24/2011] [Indexed: 02/06/2023]
Abstract
Chronic neck pain is one of the most common musculoskeletal disorders in the US. Although biomechanical and clinical studies have implicated the facet joint as a primary source of neck pain, specific cellular mechanisms still remain speculative. The purpose of this study was to investigate whether a mediator (activating transcription factor; 4ATF4) of the integrated stress response (ISR) is involved in facet-mediated pain. Holtzman rats underwent C6/C7 facet joint loading that produces either painful (n=16) or nonpainful (n=8) responses. A sham group (n=9) was also included as surgical controls. Behavioral sensitivity was measured and the C6 dorsal root ganglia (DRGs) were harvested on day 7 to evaluate the total and neuronal ATF4 expression. In separate groups, an intra-articular ketorolac injection was administered either immediately (D0 ketorolac) or 1 day (D1 ketorolac) after painful facet joint loading. Allodynia was measured at days 1 and 7 after injury to assess the effects on behavioral responses. ATF4 and BiP (an indicator of ISR activation) were separately quantified at day 7. Facet joint loading sufficient to elicit behavioral hypersensitivity produced a threefold increase in total and neuronal ATF4 expression in the DRG. After ketorolac treatment at the time of injury, ATF4 expression was significantly (P<0.01) reduced despite not producing any attenuation of behavioral responses. Interestingly, ketorolac treatment at day 1 significantly (P<0.001) alleviated behavioral sensitivity at day 7, but did not modify ATF4 expression. BiP expression was unchanged after either intervention time. Results suggest that ATF4-dependent activation of the ISR does not directly contribute to persistent pain, but it may sensitize neurons responsible for pain initiation. These behavioral and immunohistochemical findings imply that facet-mediated pain may be sustained through other pathways of the ISR.
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Affiliation(s)
- Ling Dong
- Department of Bioengineering University of Pennsylvania Philadelphia, PA 19104, USA
| | - Benjamin B. Guarino
- Department of Bioengineering University of Pennsylvania Philadelphia, PA 19104, USA
| | | | - Beth A. Winkelstein
- Department of Bioengineering University of Pennsylvania Philadelphia, PA 19104, USA
- Department of Neurosurgery University of Pennsylvania Philadelphia, PA 19104, USA
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Weisshaar CL, Winer JP, Guarino BB, Janmey PA, Winkelstein BA. The potential for salmon fibrin and thrombin to mitigate pain subsequent to cervical nerve root injury. Biomaterials 2011; 32:9738-46. [PMID: 21944723 DOI: 10.1016/j.biomaterials.2011.09.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2011] [Accepted: 09/07/2011] [Indexed: 01/23/2023]
Abstract
Nerve root compression is a common cause of radiculopathy and induces persistent pain. Mammalian fibrin is used clinically as a coagulant but presents a variety of risks. Fish fibrin is a potential biomaterial for neural injury treatment because it promotes neurite outgrowth, is non-toxic, and clots readily at lower temperatures. This study administered salmon fibrin and thrombin following nerve root compression and measured behavioral sensitivity and glial activation in a rat pain model. Fibrin and thrombin each significantly reduced mechanical allodynia compared to injury alone (p < 0.02). Painful compression with fibrin exhibited allodynia that was not different from sham for any day using stimulation by a 2 g filament; allodynia was only significantly different (p < 0.043) from sham using the 4 g filament on days 1 and 3. By day 5, responses for fibrin treatment decreased to sham levels. Allodynia following compression with thrombin treatment were unchanged from sham at any time point. Macrophage infiltration at the nerve root and spinal microglial activation were only mildly modified by salmon treatments. Spinal astrocytic expression decreased significantly with fibrin (p < 0.0001) but was unchanged from injury responses for thrombin treatment. Results suggest that salmon fibrin and thrombin may be suitable biomaterials to mitigate pain.
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Affiliation(s)
- Christine L Weisshaar
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA 19104-6321, USA.
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Chew DJ, Carlstedt T, Shortland PJ. A comparative histological analysis of two models of nerve root avulsion injury in the adult rat. Neuropathol Appl Neurobiol 2011; 37:613-32. [DOI: 10.1111/j.1365-2990.2011.01176.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Inflammatory cytokine and chemokine expression is differentially modulated acutely in the dorsal root ganglion in response to different nerve root compressions. Spine (Phila Pa 1976) 2011; 36:197-202. [PMID: 20714281 DOI: 10.1097/brs.0b013e3181ce4f4d] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Inflammatory proteins were quantified in bilateral dorsal root ganglions (DRGs) at 1 hour and 1 day using a multiplexed assay after 2 different unilateral nerve root compression injuries. OBJECTIVE To quantify cytokines and a chemokine in the DRG after nerve root compression with and without a chemical injury to determine contributing inflammatory factors in the DRG that may mediate radicular nociception in clinically relevant nerve root pathologies. SUMMARY OF BACKGROUND DATA Inflammatory cytokines are known to relate to the behavioral hypersensitivity induced after injuries to the nerve root. However, the relative expression of these proteins in the DRG after cervical nerve root compression are not known. METHODS The right C7 nerve root underwent transient compression (10 gf) or transient compression with a chemical irritation (10 gf + chr). The chemical injury was also given alone (chr), and the nerve root was exposed (sham), providing 2 types of controls. Mechanical allodynia was measured to assess behavioral outcomes. Interleukin (IL)-1b, IL-6, tumor necrosis factor-a, and macrophage inflammatory protein 3 (MIP3) were quantified in bilateral DRGs at 1 hour and 1 day using a multiplexed assay. RESULTS Ipsilateral allodynia at day 1 after 10 gf + chr was significantly increased over both 10 gf and chr (P < 0.049). Cytokines and MIP3 were not statistically increased over sham at 1 hour. By day 1 after 10 gf + chr, all proteins (IL-1β, IL-6, tumor necrosis factor-a, MIP3) were significantly increased over both normal and sham in the ipsilateral DRG (P < 0.036), and the cytokines were also significantly increased over chr (P < 0.029). Despite allodynia at day 1, cytokines at that time were not increased over normal or sham after either 10 gf or chr. CONCLUSION Nerve root compression alone may not be sufficient to induce early increases in proinflammatory cytokines in the DRG after radiculopathy and this early protein response may not be directly responsible for nociception in this type of injury.
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Rothman SM, Nicholson KJ, Winkelstein BA. Time-Dependent Mechanics and Measures of Glial Activation and Behavioral Sensitivity in a Rodent Model of Radiculopathy. J Neurotrauma 2010; 27:803-14. [DOI: 10.1089/neu.2009.1045] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Affiliation(s)
- Sarah M. Rothman
- Department of Bioengineering, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Kristen J. Nicholson
- Department of Bioengineering, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Beth A. Winkelstein
- Department of Bioengineering, University of Pennsylvania, Philadelphia, Pennsylvania
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania
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21
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Expression of calcitonin gene-related peptide in anterior and posterior horns of the spinal cord after brachial plexus injury. J Clin Neurosci 2010; 17:87-91. [DOI: 10.1016/j.jocn.2009.03.042] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2009] [Revised: 03/25/2009] [Accepted: 03/27/2009] [Indexed: 11/22/2022]
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22
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Rothman SM, Guarino BB, Winkelstein BA. Spinal microglial proliferation is evident in a rat model of painful disc herniation both in the presence of behavioral hypersensitivity and following minocycline treatment sufficient to attenuate allodynia. J Neurosci Res 2009; 87:2709-17. [DOI: 10.1002/jnr.22090] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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23
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Lee KE, Winkelstein BA. Joint distraction magnitude is associated with different behavioral outcomes and substance P levels for cervical facet joint loading in the rat. THE JOURNAL OF PAIN 2009; 10:436-45. [PMID: 19327645 DOI: 10.1016/j.jpain.2008.11.009] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2008] [Revised: 10/26/2008] [Accepted: 11/20/2008] [Indexed: 01/30/2023]
Abstract
UNLABELLED The facet joint is a common source of pain in both the neck and low back, and can be injured by abnormal loading of the spinal joints. Whereas a host of nociceptive changes including neuronal activation, neuropeptide expression, and inflammatory mediator responses has been reported for rat models of joint pain, no such responses have been explicitly investigated or quantified for painful mechanical injury to the facet joint. Two magnitudes of joint loading were separately imposed in a rat model of cervical facet joint distraction: Painful and nonpainful distractions. Behavioral outcomes were defined by assessing mechanical hyperalgesia in the shoulders and forepaws. Substance P (SP) mRNA and protein levels were quantified in the dorsal root ganglion (DRG) and spinal cord at days 1 and 7 following distraction. Painful distraction produced mechanical hyperalgesia that was significantly greater (P < .010) than that for a nonpainful distraction. Painful distraction significantly increased spinal SP mRNA (P = .048) and SP protein expression in the DRG (P = .013) at day 7 compared to nonpainful distraction. However, spinal SP protein for painful distraction was significantly less (P = .024) than that for nonpainful distraction at day 1. Joint distractions producing different behavioral outcomes modulate SP mRNA and protein in the DRG and spinal cord, suggesting that SP responses may be involved with different temporal responses in painful joint loading. PERSPECTIVE SP mRNA and protein in the DRG and spinal cord are quantified at 2 time points after cervical facet joint distractions that separately do or do not produce mechanical hyperalgesia. Studies describe a role for SP to contribute to pain produced by mechanical joint loading.
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Affiliation(s)
- Kathryn E Lee
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA 19104-6392, USA
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Siegmund GP, Winkelstein BA, Ivancic PC, Svensson MY, Vasavada A. The anatomy and biomechanics of acute and chronic whiplash injury. TRAFFIC INJURY PREVENTION 2009; 10:101-112. [PMID: 19333822 DOI: 10.1080/15389580802593269] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Whiplash injury is the most common motor vehicle injury, yet it is also one of the most poorly understood. Here we examine the evidence supporting an organic basis for acute and chronic whiplash injuries and review the anatomical sites within the neck that are potentially injured during these collisions. For each proposed anatomical site--facet joints, spinal ligaments, intervertebral discs, vertebral arteries, dorsal root ganglia, and neck muscles--we present the clinical evidence supporting that injury site, its relevant anatomy, the mechanism of and tolerance to injury, and the future research needed to determine whether that site is responsible for some whiplash injuries. This article serves as a snapshot of the current state of whiplash biomechanics research and provides a roadmap for future research to better understand and ultimately prevent whiplash injuries.
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Affiliation(s)
- Gunter P Siegmund
- MEA Forensic Engineers & Scientists, 11-11151 Horseshoe Way, Richmond, BC, Canada.
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25
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Spinal substance P and neurokinin-1 increase with high repetition reaching. Neurosci Lett 2009; 454:33-7. [PMID: 19429049 DOI: 10.1016/j.neulet.2009.01.037] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2008] [Revised: 01/15/2009] [Accepted: 01/15/2009] [Indexed: 12/26/2022]
Abstract
Musculoskeletal injury and inflammation is associated with performance of repetitive and forceful tasks. In this study, we examined the effects of performing a voluntary, highly repetitive, negligible force (HRNF) reaching task on spinal cord neurochemicals involved in nociception. To our knowledge, no other laboratories are examining spinal cord nociceptive neurochemicals in response to repetitive motion-induced injury and inflammation. The purpose of this study was to extend our earlier findings related to central neurotransmitters from a low demand task to a higher demand task. Specifically, this study determined immunoreactivity of a peptidergic pro-nociceptive transmitter (substance P) and one of its receptors, neurokinin-1 (NK-1) receptor, in spinal cord dorsal horns in rats performing a HRNF reaching task for 6-10 weeks. The relationship of these spinal cord changes with the number of TNFalpha immunopositive cells in flexor forelimb muscles and with previously observed forearm grip strength changes from these same rats were examined. Performance of the HRNF task resulted in significantly increased substance P and NK-1 receptor immunoreactivity in the superficial lamina of spinal cord dorsal horns at 6 and 10 weeks compared to trained controls (p<0.01). The increased substance P and NK-1 receptor immmunoreactivity were positively correlated with declines in forearm grip strength, an assay of movement-related hyperalgesia (r=0.70, p<0.01 and r=0.64, p<0.05, respectively). The increased substance P and NK-1 receptor immmunoreactivity were also positively correlated with increased TNF immunopositive cells in forelimb flexor muscles (r=0.85, p<0.001 and r=0.88, p<0.001, respectively). Thus, our highly repetitive task leads to increased spinal cord pro-nociceptive neurochemicals that are most likely directed by forelimb muscle inflammation and pain.
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Hubbard RD, Martínez JJ, Burdick JA, Winkelstein BA. Controlled release of GDNF reduces nerve root-mediated behavioral hypersensitivity. J Orthop Res 2009; 27:120-7. [PMID: 18634009 PMCID: PMC2605213 DOI: 10.1002/jor.20710] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Nerve root compression produces persistent behavioral sensitivity in models of painful neck injury. This study utilized degradable poly(ethylene glycol) hydrogels to deliver glial cell line-derived neurotrophic factor (GDNF) to an injured nerve root. Hydrogels delivered approximately 98% of encapsulated GDNF over 7 days in an in vitro release assay without the presence of neurons and produced enhanced outgrowth of processes in cortical neural cell primary cultures. The efficacy of a GDNF hydrogel placed on the root immediately after injury was assessed in a rat pain model of C7 dorsal root compression. Control groups included painful injury followed by: (1) vehicle hydrogel treatment (no GDNF), (2) a bolus injection of GDNF, or (3) no treatment. After injury, mechanical allodynia (n = 6/group) was significantly decreased with GDNF delivered by the hydrogel compared to the three injury control groups (p < 0.03). The bolus GDNF treatment did not reduce allodynia at any time point. The GDNF receptor (GFRalpha-1) decreased in small, nociceptive neurons of the affected dorsal root ganglion, suggesting a decrease in receptor expression following injury. GDNF receptor immunoreactivity was significantly greater in these neurons following GDNF hydrogel treatment relative to GDNF bolus treated and untreated rats (p < 0.05). These data suggest efficacy for degradable hydrogel delivery of GDNF and support this treatment approach for nerve root-mediated pain.
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Affiliation(s)
- Raymond D. Hubbard
- Department of Bioengineering University of Pennsylvania Philadelphia, PA 19104, USA
| | - Joan J. Martínez
- Department of Bioengineering University of Pennsylvania Philadelphia, PA 19104, USA
| | - Jason A. Burdick
- Department of Bioengineering University of Pennsylvania Philadelphia, PA 19104, USA
| | - Beth A. Winkelstein
- Department of Bioengineering University of Pennsylvania Philadelphia, PA 19104, USA
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Elliott MB, Barr AE, Clark BD, Amin M, Amin S, Barbe MF. High force reaching task induces widespread inflammation, increased spinal cord neurochemicals and neuropathic pain. Neuroscience 2008; 158:922-31. [PMID: 19032977 DOI: 10.1016/j.neuroscience.2008.10.050] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2008] [Revised: 10/27/2008] [Accepted: 10/29/2008] [Indexed: 01/30/2023]
Abstract
Repetitive strain injuries (RSI), which include several musculoskeletal disorders and nerve compression injuries, are associated with performance of repetitive and forceful tasks. In this study, we examined in young, adult Sprague-Dawley rats, the effects of performing a voluntary, moderate repetition, high force (MRHF; nine reaches/min; 60% maximum pulling force) task for 12 weeks on motor behavior and nerve function, inflammatory responses in forearm musculoskeletal and nerve tissues and serum, and neurochemical immunoexpression in cervical spinal cord dorsal horns. We observed no change in reach rate, but reduced voluntary participation and grip strength in week 12, and increased cutaneous sensitivity in weeks 6 and 12, the latter indicative of mechanical allodynia. Nerve conduction velocity (NCV) decreased 15% in the median nerve in week 12, indicative of low-grade nerve compression. ED-1 cells increased in distal radius and ulna in week 12, and in the median nerve and forearm muscles and tendons in weeks 6 and 12. Cytokines IL-1alpha, IL-1beta, TNF-alpha, and IL-10 increased in distal forearm bones in week 12, while IL-6 increased in tendon in week 12. However, serum analysis revealed only increased TNF-alpha in week 6 and macrophage inflammatory protein 3a (MIP3a) in weeks 6 and 12. Lastly, Substance P and neurokinin-1 were both increased in weeks 6 and 12 in the dorsal horns of cervical spinal cord segments. These results show that a high force, but moderate repetition task, induced declines in motor and nerve function as well as peripheral and systemic inflammatory responses (albeit the latter was mild). The peripheral inflammatory responses were associated with signs of central sensitization (mechanical allodynia and increased neurochemicals in spinal cord dorsal horns).
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Affiliation(s)
- M B Elliott
- Department of Physical Therapy, Temple University, 3307 North Broad Street, Philadelphia, PA 19140, USA.
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28
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Lee KE, Davis MB, Winkelstein BA. Capsular Ligament Involvement in the Development of Mechanical Hyperalgesia after Facet Joint Loading: Behavioral and Inflammatory Outcomes in a Rodent Model of Pain. J Neurotrauma 2008; 25:1383-93. [DOI: 10.1089/neu.2008.0700] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Kathryn E. Lee
- Department of Bioengineering, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Martin B. Davis
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Beth A. Winkelstein
- Department of Bioengineering, University of Pennsylvania, Philadelphia, Pennsylvania
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania
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29
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Rothman SM, Huang Z, Lee KE, Weisshaar CL, Winkelstein BA. Cytokine mRNA expression in painful radiculopathy. THE JOURNAL OF PAIN 2008; 10:90-9. [PMID: 18848809 DOI: 10.1016/j.jpain.2008.07.008] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2008] [Revised: 07/18/2008] [Accepted: 07/29/2008] [Indexed: 01/01/2023]
Abstract
UNLABELLED Inflammatory cytokines contribute to lumbar radiculopathy. Regulation of cytokines for transient cervical injuries, with or without longer-lasting inflammation, remains to be defined. The C7 root in the rat underwent compression (10gf), chromic gut suture exposure (chr), or their combination (10gf+chr). Ipsilateral C7 spinal cord and dorsal root ganglia (DRG) were harvested at 1 hour after injury for real-time PCR analysis of IL-1beta, IL-6, and TNF-alpha. Cytokine mRNA increased after all 3 injuries. TNF-alpha mRNA in the DRG was significantly increased over sham after 10gf+chr (P = .026). Spinal IL-1beta was significantly increased over sham after 10gf and 10gf+chr (P < .024); IL-6 was significantly increased after 10gf+chr (P < .024). In separate studies, the soluble TNF-alpha receptor was administered at injury and again at 6 hours in all injury paradigms. Allodynia was assessed and tissue samples were harvested for cytokine PCR. Allodynia significantly decreased with receptor administration for 10gf and 10gf+chr (P < .005). Treatment also significantly decreased IL-1beta and TNF-alpha mRNA in the DRG for 10gf+chr (P < .028) at day 1. Results indicate an acute, robust cytokine response in cervical nerve root injury with varying patterns, dependent on injury type, and that early increases in TNF-alpha mRNA in the DRG may drive pain-related signaling for transient cervical injuries. PERSPECTIVE Inflammatory cytokine mRNA in the DRG and spinal cord are defined after painful cervical nerve root injury. Studies describe a role for TNF-alpha in mediating behavioral sensitivity and inflammatory cytokines in transient painful radiculopathy. Results outline an early response of inflammatory cytokine upregulation in cervical pain.
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Affiliation(s)
- Sarah M Rothman
- Department of Bioengineering, University of Pennsylvania, Philadelphia, Pennsylvania 19104-6321, USA
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30
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Singaraju VM, Kang RW, Yanke AB, McNickle AG, Lewis PB, Wang VM, Williams JM, Chubinskaya S, Romeo AA, Cole BJ. Biceps tendinitis in chronic rotator cuff tears: a histologic perspective. J Shoulder Elbow Surg 2008; 17:898-904. [PMID: 18786837 DOI: 10.1016/j.jse.2008.05.044] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2007] [Revised: 04/02/2008] [Accepted: 05/16/2008] [Indexed: 02/01/2023]
Abstract
Patients with chronic rotator cuff tears frequently have anterior shoulder pain attributed to the long head of the biceps brachii (LHBB) tendon. In this study, tenodesis or tenotomy samples and cadaveric controls were assessed by use of immunohistochemical and histologic methods to quantify inflammation, vascularity, and neuronal plasticity. Patients had moderate pain and positive results on at least 1 clinical test of shoulder function. The number of axons in the distal LHBB was significantly less in patients with biceps tendinitis. Calcitonin gene-related peptide and substance P immunostaining was predominantly within nerve roots and blood vessels. A moderate correlation (R = 0.5) was identified between LHBB vascularity and pain scores. On the basis of these results, we conclude that, in the context of rotator cuff disease, the etiology of anterior shoulder pain with macroscopic changes in the biceps tendon is related to the complex interaction of the tendon and surrounding soft tissues, rather than a single entity.
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Affiliation(s)
- Vamsi M Singaraju
- Department of Orthopedic Surgery, Hamot Medical Center, Erie, PA, USA
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31
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Sasaki M, Abekura M, Morris S, Kataoka Y, Yoshimura K, Ninomiya K, Iwatsuki K, Yoshimine T. Allodynia corresponding to the levels of cervical cord injury treated by surgical decompression: a report of 3 cases. SURGICAL NEUROLOGY 2008; 72:281-5; discussion 285. [PMID: 18614217 DOI: 10.1016/j.surneu.2008.05.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2008] [Accepted: 05/12/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND The role and timing of surgical decompression for SCI remains controversial, when the surgical outcomes are evaluated only by neurologic recovery. Other than neurologic deficits, severe pain after SCI is a significant problem, deteriorating the patient's activity of daily living. In the present report, allodynia of patients' upper limbs caused by cervical SCI was treated successfully by surgical decompression. CASE DESCRIPTIONS Three male patients received cervical SCI through minor accidents. They complained of allodynia and motor dysfunction at the spinal level compressed by preexisting lower cervical spondylosis, but they lacked symptoms or neurologic abnormalities below that spinal level. Severe pain was induced by soft touch or exposure to water at room temperature preoperatively. Surgical decompressions of the spinal cord and nerve roots were performed between 20 and 83 days (mean, 48.7 days) after the SCI. Allodynia was reduced in all patients immediately after surgery. Pain induced by soft touch disappeared within 4 days of operations, whereas pain by water exposure diminished within months. Recurrence of allodynia has not been observed in patients at least until the last follow-up, within periods ranging from 15 to 39 months (average, 26 months). The mean preoperative VAS was 6.0, and this improved to 2.2 at 1 month and 0.8 at the final follow-up. CONCLUSION We propose that patients with SCI with allodynia and motor dysfunction of the upper limbs related only to the compressed spinal levels are potentially treatable by surgical decompression.
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Affiliation(s)
- Manabu Sasaki
- Department of Neurosurgery and Spine Surgery, Yukioka Hospital, Osaka 530-0021, Japan.
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Hubbard RD, Winkelstein BA. Dorsal root compression produces myelinated axonal degeneration near the biomechanical thresholds for mechanical behavioral hypersensitivity. Exp Neurol 2008; 212:482-9. [PMID: 18572166 DOI: 10.1016/j.expneurol.2008.04.042] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2007] [Revised: 04/24/2008] [Accepted: 04/28/2008] [Indexed: 11/28/2022]
Abstract
Increased sensitivity to mechanical stimuli produced by transient cervical nerve root compression is dependent on the severity of applied load. In addition, trauma in the nervous system induces local inflammation, Wallerian degeneration, and a host of other degenerative processes leading to axonal dysfunction. Here, axonal degeneration and inflammation were assessed following transient dorsal root compression to establish a relationship between conditions for dorsal root axonal changes and those previously established for the onset and maintenance of mechanical behavioral hypersensitivity (26.3 mN and 38.2 mN, respectively). Compression loads were applied over a range (0-110 mN) known to produce sustained behavioral hypersensitivity. CD68- and NF200-immunoreactivity, as well as axonal pathological changes, were assessed in the dorsal root to investigate the load thresholds requisite for inducing macrophage infiltration and axonal degeneration relative to those thresholds for producing the onset and persistence of behavioral hypersensitivity. Neurofilament accumulation and the depletion of NF200-immunoreactivity in the region of compressed tissue were produced for loads that produce mechanical behavioral hypersensitivity. A 50th-percentile load threshold was determined (31.6 mN) governing the onset of NF200 depletion. However, CD68-immunoreactivity was increased for nearly all loads, suggesting that macrophage recruitment may not be directly related to nerve root-mediated behavioral hypersensitivity. This study provides new evidence for threshold-mediated degenerative changes in the context of behavioral hypersensitivity following nerve root compression.
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Affiliation(s)
- Raymond D Hubbard
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA 19104, USA
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Elliott MB, Barr AE, Kietrys DM, Al-Shatti T, Amin M, Barbe MF. Peripheral neuritis and increased spinal cord neurochemicals are induced in a model of repetitive motion injury with low force and repetition exposure. Brain Res 2008; 1218:103-13. [PMID: 18511022 DOI: 10.1016/j.brainres.2008.04.029] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2007] [Revised: 03/14/2008] [Accepted: 04/03/2008] [Indexed: 12/31/2022]
Abstract
Performance of high repetition tasks with or without force is associated with peripheral tissue inflammation, decreased nerve function and motor dysfunction. Here, we examined whether a low repetition task with negligible force (LRNF) produces fewer tissue and behavioral pathologies than previously observed with high repetition tasks using our rat model of repetitive motion injury (RMI). Thirty-seven rats were randomized into control or LRNF groups, the latter reaching and grasping a 45 mg food pellet at a rate of 3 reaches/min. This task was performed in 4, 0.5 5 h sessions with 1.5 5 h rest periods for 3 days/week for up to 12 weeks. Examination of distal median nerve, forelimb flexor tendons and bones for ED1-positive cells (macrophages and osteoclasts) revealed increases in nerve and bone in week 12. The nerve also contained increased TNF-alpha expressing cells in week 12. Examination of spinal cord dorsal horns revealed increased immunoexpression of Substance P in week 8 and neurokinin-1 in weeks 8 and 12 in the superficial lamina. Motor behavioral analyses showed no changes in reach rate across weeks, slightly reduced task duration (a measurement of voluntary task participation) in week 12, but significantly increased extra arm movement reversals during reaching in week 8. These extra movement reversals were corrections for missed food pellets during a reach. Thus, performance of even a low repetition, negligible force upper extremity task for 3 months can induce mild peripheral tissue inflammation, neurochemical increases in spinal cord dorsal horns, and declines in fine motor control.
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Affiliation(s)
- Melanie B Elliott
- Department of Physical Therapy, Temple University, 3307 North Broad St., Philadelphia, PA 19140, USA.
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An intact facet capsular ligament modulates behavioral sensitivity and spinal glial activation produced by cervical facet joint tension. Spine (Phila Pa 1976) 2008; 33:856-62. [PMID: 18404104 DOI: 10.1097/brs.0b013e31816b4710] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN In vivo experiments using a rat model of painful facet joint distraction. OBJECTIVE To determine whether tension of the facet capsular ligament is requisite for producing pain for joint loading and to define effects on spinal glial activation. SUMMARY OF BACKGROUND DATA Cervical facet joint loading may initiate pain for certain conditions. While facet capsule tension has been proposed as requisite for pain, this hypothesis has not been tested. METHODS Using an established rat model of painful C6-C7 distraction, tension was applied after transection of the left facet capsule; the right capsule remained intact. Each rat (n = 8) received the same distraction simultaneously applied across both the intact and cut capsules. Sham procedures were performed on separate rats (n = 4) with no joint distraction. Bilateral forepaw mechanical allodynia was measured as a pain outcome. Cervical spinal cord tissue (C7) was harvested on day 7 to detect glial reactivity using immunohistochemistry. RESULTS Distraction mechanics were consistent with conditions eliciting persistent behavioral hypersensitivity. Allodynia was produced for an intact capsule and was significantly elevated over both the cut capsule (P < 0.004) and sham (P < 0.002). Transecting the capsule before distraction did not produce elevated allodynia, except on day 7. Spinal astrocytic reactivity paralleled allodynia; glial fibrillary acidic protein expression for an intact capsule was significantly greater than the cut and sham responses (P < 0.04), with no difference observed between the cut and sham spinal astrocytic reactivity. Spinal microglial activation did not differ between groups. CONCLUSION Results suggest ligament tension may be required to produce pain from facet joint loading. Further studies of other cellular responses are needed to define the mechanisms of painful facet joint injury.
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35
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Synapse involvement of the dorsal horn in experimental lumbar nerve root compression: a light and electron microscopic study. Spine (Phila Pa 1976) 2008; 33:716-23. [PMID: 18379397 DOI: 10.1097/brs.0b013e318169500e] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN This study was aimed at investigating changes in the dorsal horn of the lumbar cord induced by mechanical compression using an in vivo model. OBJECTIVE To determine the effect of axonal flow disturbance in the dorsal horns induced by nerve root compression. SUMMARY OF BACKGROUND DATA Few studies have looked at changes of synapses within the dorsal horn caused by disturbance of axonal flow and the axon reaction as a result of mechanical compression of the dorsal root. METHODS In mongrel dogs, the 7th lumbar nerve root was compressed for 1 week, or 3 weeks using a clip. After intravenous injection of Evans blue albumin, they were observed under a fluorescence microscope for the purpose of clarifying the function of the blood-spinal cord barrier. Morphologic changes of the synapses in the dorsal horns secondary to the nerve fiber degeneration were examined by light and electron microscope. Changes on immuno-staining for substance P, calcitonin gene-related peptide, and somatostatin in the dorsal horn were also examined. RESULTS Light microscope observation conducted 1 week after compression of the nerve roots revealed Wallerian degeneration of the myelinated nerve in the dorsal horn, and fluorescence microscope observation of these areas demonstrated edema formation resulting from damage of the blood-spinal cord barrier. Three weeks after the compression, electron microscope observation revealed shrinkage of the axon terminals, ubiquitous presence of high electron density degeneration and presence of synapses whose contact with synapses was disrupted. Immuno-histochemical studies showed a marked decrease of substance P, calcitonin gene-related peptide, and somatostatin staining in substance gelatinosa with Wallerian degeneration after compression of nerve root. CONCLUSION It is important to recognize that compressive disturbance of the nerve roots caused Wallerian degeneration not only at the site of compression of nerve roots but also at the synapses of spinal cord dorsal horns.
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Hubbard RD, Chen Z, Winkelstein BA. Transient cervical nerve root compression modulates pain: load thresholds for allodynia and sustained changes in spinal neuropeptide expression. J Biomech 2007; 41:677-85. [PMID: 17976629 DOI: 10.1016/j.jbiomech.2007.09.026] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2007] [Revised: 09/24/2007] [Accepted: 09/25/2007] [Indexed: 10/22/2022]
Abstract
Nerve root compression produces chronic pain and altered spinal neuropeptide expression. This study utilized controlled transient loading in a rat model of painful cervical nerve root compression to investigate the dependence of mechanical allodynia on load magnitude. Injury loads (0-110mN) were applied quasistatically using a customized loading device, and load thresholds to produce maintained mechanical allodynia were defined. Bilateral spinal expression of substance P (SP) and calcitonin gene-related peptide (CGRP) was assessed 7 days following compression using immunohistochemistry to determine relationships between these neuropeptides and compression load. A three-segment change point model was implemented to model allodynia responses and their relationship to load. Load thresholds were defined at which ipsilateral and contralateral allodynia were produced and sustained. The threshold for increased allodynia was lowest for acute (day 1) ipsilateral responses (26.29mN), while thresholds for allodynia on day 7 were similar for the ipsilateral (38.16mN) and contralateral forepaw (38.26mN). CGRP, but not SP, significantly decreased with load; the thresholds for ipsilateral and contralateral CGRP decreases corresponded to 19.52 and 24.03mN, respectively. These thresholds suggest bilateral allodynia may be mediated by spinal mechanisms, and that these mechanisms depend on the magnitude of load.
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Affiliation(s)
- Raymond D Hubbard
- Department of Bioengineering, University of Pennsylvania, 240 Skirkanich Hall, 210 South 33rd Street, Philadelphia, PA 19104-6321, USA
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Rothman SM, Winkelstein BA. Chemical and mechanical nerve root insults induce differential behavioral sensitivity and glial activation that are enhanced in combination. Brain Res 2007; 1181:30-43. [PMID: 17920051 DOI: 10.1016/j.brainres.2007.08.064] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2007] [Revised: 07/19/2007] [Accepted: 08/28/2007] [Indexed: 12/24/2022]
Abstract
Both chemical irritation and mechanical compression affect radicular pain from disc herniation. However, relative effects of these insults on pain symptoms are unclear. This study investigated chemical and mechanical contributions for painful cervical nerve root injury. Accordingly, the C7 nerve root separately underwent chromic gut exposure, 10gf compression, or their combination. Mechanical allodynia was assessed, and glial reactivity in the C7 spinal cord tissue was assayed at days 1 and 7 by immunohistochemistry using GFAP and OX-42 as markers of astrocytes and microglia, respectively. Both chromic gut irritation and 10gf compression produced ipsilateral increases in allodynia over sham (p<0.048); combining the two insults significantly (p<0.027) increased ipsilateral allodynia compared to either insult alone. Behavioral hypersensitivity was also produced in the contralateral forepaw for all injuries, but only the combined insult was significantly increased over sham (p<0.031). Astrocytic activation was significantly increased over normal (p<0.001) in the ipsilateral dorsal horn at 1 day after either compression or the combined injury. By day 7, GFAP-reactivity was further increased for the combined injury compared to day 1 (p<0.001). In contrast, spinal OX-42 staining was generally variable, with only mild activation at day 1. By day 7 after the combined injury, there were significant (p<0.003) bilateral increases in OX-42 staining over normal. Spinal astrocytic and microglial reactivity follow different patterns after chemical root irritation, compression, and a combined insult. The combination of transient compression and chemical irritation produces sustained bilateral hypersensitivity, sustained ipsilateral spinal astrocytic activation and late onset bilateral spinal microglial activation.
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Affiliation(s)
- Sarah M Rothman
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA 19104, USA
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Takeuchi H, Kawaguchi S, Ohwada O, Kobayashi H, Hayakawa M, Takebayashi T, Torigoe T, Sato N, Yamashita T. Plasma neuropeptides in patients undergoing lumbar discectomy. Spine (Phila Pa 1976) 2007; 32:E79-84. [PMID: 17224803 DOI: 10.1097/01.brs.0000252204.88750.cf] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A prospective analysis of patients with lumbar disc herniation (LDH). OBJECTIVES To determine the role of neuropeptides as a biochemical signature of pain states in patients with LDH. SUMMARY OF BACKGROUND DATA Increases in the plasma level of neuropeptides have been reported in patients suffering from a variety of painful conditions. However, there is no such report on patients with LDH. METHODS From a total of 27 patients with a single-level LDH, blood samples were collected before and 3 weeks after lumbar discectomy. Plasma levels of alpha calcitonin gene-related peptide (CGRP), galanin, neuropeptide Y, and substance P were determined by using enzyme-linked immunosorbent assay. The association or correlation between preoperative concentration of plasma neuropeptides and gender, patients' age, and VAS were analyzed statistically. Also, the concentration of plasma neuropeptides was compared before and after lumbar discectomy. RESULTS Preoperative plasma levels of CGRP were correlated significantly with the extent of sciatica as determined by VAS. In addition, plasma levels of CGRP and galanin significantly decreased after lumbar discectomy in line with the disappearance of pain symptoms. CONCLUSIONS These findings indicate the role of plasma CGRP and possibly galanin as a systemic neurochemical signature of pain states in patients with LDH.
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Affiliation(s)
- Hirohito Takeuchi
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan
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