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Roubaud MS, Hassan AM, Shin A, Mericli AF, Adelman DM, Hagan K, Popat K, Lin P, Moon B, Lewis VO. Outcomes of Targeted Muscle Reinnervation and Regenerative Peripheral Nerve Interfaces for Chronic Pain Control in the Oncologic Amputee Population. J Am Coll Surg 2023; 237:644-654. [PMID: 37278406 DOI: 10.1097/xcs.0000000000000778] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND Outcomes of targeted muscle reinnervation (TMR) and regenerative peripheral nerve interface (RPNI) in the oncologic population are limited. We sought to examine the safety and effectiveness of TMR and RPNI in controlling postamputation pain in the oncologic population. STUDY DESIGN A retrospective cohort study of consecutive patients who underwent oncologic amputation followed by immediate TMR or RPNI was conducted from November 2018 to May 2022. The primary study outcome was postamputation pain, assessed using the Numeric Pain Scale and Patient-Reported Outcomes Measurement Information System (PROMIS) for residual limb pain (RLP) and phantom limb pain (PLP). Secondary outcomes included postoperative complications, tumor recurrence, and opioid use. RESULTS Sixty-three patients were evaluated for a mean follow-up period of 11.3 months. The majority of patients (65.1%) had a history of previous limb salvage. At final follow-up, patients had an average Numeric Pain Scale score for RLP of 1.3 ± 2.2 and for PLP, 1.9 ± 2.6. The final average raw PROMIS measures were pain intensity 6.2 ± 2.9 (T-score 43.5), pain interference 14.6 ± 8.3 (T-score 55.0), and pain behavior 39.0 ± 22.1 (T-score 53.4). Patient opioid use decreased from 85.7% preoperatively to 37.7% postoperatively and morphine milligram equivalents decreased from a mean of 52.4 ± 53.0 preoperatively to 20.2 ± 38.4 postoperatively. CONCLUSIONS In the oncologic population TMR and RPNI are safe surgical techniques associated with significant reductions in RLP, PLP, and improvements in patient-reported outcomes. This study provides evidence for the routine incorporation of TMR and RPNI in the multidisciplinary care of oncologic amputees.
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Affiliation(s)
- Margaret S Roubaud
- From the Departments of Plastic and Reconstructive Surgery (Roubaud, Hassan, Mericli, Adelman), The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Abbas M Hassan
- From the Departments of Plastic and Reconstructive Surgery (Roubaud, Hassan, Mericli, Adelman), The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Ashley Shin
- University of Texas, McGovern Medical School, Houston, TX (Shin)
| | - Alexander F Mericli
- From the Departments of Plastic and Reconstructive Surgery (Roubaud, Hassan, Mericli, Adelman), The University of Texas MD Anderson Cancer Center, Houston, TX
| | - David M Adelman
- From the Departments of Plastic and Reconstructive Surgery (Roubaud, Hassan, Mericli, Adelman), The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Katherine Hagan
- Anesthesiology and Perioperative Medicine (Hagan, Popat), The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Keyuri Popat
- Anesthesiology and Perioperative Medicine (Hagan, Popat), The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Patrick Lin
- Orthopedic Surgery (Lin, Moon, Lewis), The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Bryan Moon
- Orthopedic Surgery (Lin, Moon, Lewis), The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Valerae O Lewis
- Orthopedic Surgery (Lin, Moon, Lewis), The University of Texas MD Anderson Cancer Center, Houston, TX
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Roubaud M, Asaad M, Liu J, Mericli A, Kapur S, Adelman D, Hanasono M. Free Fillet Flap of Lower Extremity: 38 Amputations with Seven Examples of Targeted Muscle Reinnervation and Regenerative Peripheral Nerve Interfaces. Plast Reconstr Surg 2023; 152:883-895. [PMID: 36780349 DOI: 10.1097/prs.0000000000010294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
BACKGROUND Extremely high-level lower extremity amputations are rare procedures that require significant soft-tissue and bony reconstruction. This study describes the use of fillet flaps for oncologic reconstruction and the incorporation of targeted muscle reinnervation (TMR) and regenerative peripheral nerve interfaces (RPNIs) for chronic pain prevention. METHODS The authors performed a retrospective review of patients who underwent lower extremity fillet flaps at MD Anderson Cancer Center from January of 2004 through April of 2021. Surgical outcomes were summarized and compared. Numeric rating scale and patient-reported outcomes measures were collected. RESULTS Thirty-eight fillet flaps were performed for lower extremity reconstruction. Extirpative surgery included external hemipelvectomy (42%), external hemipelvectomy with sacrectomy (32%), and supratrochanteric above-knee amputation (26%). Median defect size was 600 cm 2 , and 50% included a bony component. Twenty-one patients (55%) experienced postoperative complications, with 16 requiring operative intervention. There was an increased trend toward complications in patients with preoperative radiotherapy, although this was not significant (44% versus 65%; P = 0.203). Seven patients underwent TMR or RPNI. In these patients, the mean numeric rating scale residual limb pain score was 2.8 ± 3.4 ( n = 5; range, 0 to 4/10) and phantom limb pain was 4 ± 3.2 ( n = 6; range, 0 to 7/10). The mean Patient-Reported Outcomes Measures Information Systems T scores were as follows: pain intensity, 50.8 ± 10.6 ( n = 6; range, 30.7 to 60.5); pain interference, 59.2 ± 12.1 ( n = 5; range, 40.7 to 70.1); and pain behavior, 62.3 ± 6.7 ( n = 3; range, 54.6 to 67.2). CONCLUSIONS Lower limb fillet flaps are reliable sources of bone, soft tissue, and nerve for reconstruction of oncologic amputation. TMR or RPNI are important new treatment adjuncts that should be considered during every amputation. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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Affiliation(s)
- Margaret Roubaud
- From the Department of Plastic and Reconstructive Surgery, The University of Texas MD Anderson Cancer Center
| | - Malke Asaad
- Department of Plastic Surgery, University of Pittsburgh Medical Center
| | - Jun Liu
- From the Department of Plastic and Reconstructive Surgery, The University of Texas MD Anderson Cancer Center
| | - Alexander Mericli
- From the Department of Plastic and Reconstructive Surgery, The University of Texas MD Anderson Cancer Center
| | - Sahil Kapur
- From the Department of Plastic and Reconstructive Surgery, The University of Texas MD Anderson Cancer Center
| | - David Adelman
- From the Department of Plastic and Reconstructive Surgery, The University of Texas MD Anderson Cancer Center
| | - Matthew Hanasono
- From the Department of Plastic and Reconstructive Surgery, The University of Texas MD Anderson Cancer Center
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Vogel A, Ueberbach T, Wilken-Schmitz A, Hahnefeld L, Franck L, Weyer MP, Jungenitz T, Schmid T, Buchmann G, Freudenberg F, Brandes RP, Gurke R, Schwarzacher SW, Geisslinger G, Mittmann T, Tegeder I. Repetitive and compulsive behavior after Early-Life-Pain associated with reduced long-chain sphingolipid species. Cell Biosci 2023; 13:155. [PMID: 37635256 PMCID: PMC10463951 DOI: 10.1186/s13578-023-01106-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 08/13/2023] [Indexed: 08/29/2023] Open
Abstract
BACKGROUND Pain in early life may impact on development and risk of chronic pain. We developed an optogenetic Cre/loxP mouse model of "early-life-pain" (ELP) using mice with transgenic expression of channelrhodopsin-2 (ChR2) under control of the Advillin (Avil) promoter, which drives expression of transgenes predominantly in isolectin B4 positive non-peptidergic nociceptors in postnatal mice. Avil-ChR2 (Cre +) and ChR2-flfl control mice were exposed to blue light in a chamber once daily from P1-P5 together with their Cre-negative mother. RESULTS ELP caused cortical hyperexcitability at P8-9 as assessed via multi-electrode array recordings that coincided with reduced expression of synaptic genes (RNAseq) including Grin2b, neurexins, piccolo and voltage gated calcium and sodium channels. Young adult (8-16 wks) Avil-ChR2 mice presented with nociceptive hypersensitivity upon heat or mechanical stimulation, which did not resolve up until one year of age. The persistent hypersensitivy to nociceptive stimuli was reflected by increased calcium fluxes in primary sensory neurons of aged mice (1 year) upon capsaicin stimulation. Avil-ChR2 mice behaved like controls in maze tests of anxiety, social interaction, and spatial memory but IntelliCage behavioral studies revealed repetitive nosepokes and corner visits and compulsive lickings. Compulsiveness at the behavioral level was associated with a reduction of sphingomyelin species in brain and plasma lipidomic studies. Behavioral studies were done with female mice. CONCLUSION The results suggest that ELP may predispose to chronic "pain" and compulsive psychopathology in part mediated by alterations of sphingolipid metabolism, which have been previously described in the context of addiction and psychiatric diseases.
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Affiliation(s)
- Alexandra Vogel
- Institute of Clinical Pharmacology, Faculty of Medicine, Goethe-University, Frankfurt, Germany
| | - Timo Ueberbach
- Institute of Physiology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Annett Wilken-Schmitz
- Institute of Clinical Pharmacology, Faculty of Medicine, Goethe-University, Frankfurt, Germany
| | - Lisa Hahnefeld
- Institute of Clinical Pharmacology, Faculty of Medicine, Goethe-University, Frankfurt, Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, 60596, Frankfurt, Germany
- Fraunhofer Cluster of Excellence for Immune Mediated Diseases (CIMD), 60596, Frankfurt, Germany
| | - Luisa Franck
- Institute of Clinical Pharmacology, Faculty of Medicine, Goethe-University, Frankfurt, Germany
| | - Marc-Philipp Weyer
- Institute of Clinical Pharmacology, Faculty of Medicine, Goethe-University, Frankfurt, Germany
| | - Tassilo Jungenitz
- Institute of Clinical Neuroanatomy, Neuroscience Center, Goethe University, Frankfurt, Germany
| | - Tobias Schmid
- Institute of Biochemistry I, Faculty of Medicine, Goethe-University, Frankfurt, Germany
- Partner Site Frankfurt, German Cancer Consortium (DKTK), Frankfurt, Germany
| | - Giulia Buchmann
- Institute of Cardiovascular Physiology, Faculty of Medicine, Goethe-University, Frankfurt, Germany
| | - Florian Freudenberg
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, Goethe-University Hospital, Frankfurt, Germany
| | - Ralf P Brandes
- Institute of Cardiovascular Physiology, Faculty of Medicine, Goethe-University, Frankfurt, Germany
| | - Robert Gurke
- Institute of Clinical Pharmacology, Faculty of Medicine, Goethe-University, Frankfurt, Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, 60596, Frankfurt, Germany
- Fraunhofer Cluster of Excellence for Immune Mediated Diseases (CIMD), 60596, Frankfurt, Germany
| | - Stephan W Schwarzacher
- Institute of Clinical Neuroanatomy, Neuroscience Center, Goethe University, Frankfurt, Germany
| | - Gerd Geisslinger
- Institute of Clinical Pharmacology, Faculty of Medicine, Goethe-University, Frankfurt, Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, 60596, Frankfurt, Germany
- Fraunhofer Cluster of Excellence for Immune Mediated Diseases (CIMD), 60596, Frankfurt, Germany
| | - Thomas Mittmann
- Institute of Physiology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Irmgard Tegeder
- Institute of Clinical Pharmacology, Faculty of Medicine, Goethe-University, Frankfurt, Germany.
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Basnet R, Mendez DR, Lugo-González I, O'Hagan E, O'Keeffe M, Sharma S, Pate JW, Kennedy DS. Online information on chronic pain in 3 countries: an assessment of readability, credibility, and accuracy. Pain Rep 2023; 8:e1078. [PMID: 37342519 PMCID: PMC10278708 DOI: 10.1097/pr9.0000000000001078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 03/10/2023] [Accepted: 03/23/2023] [Indexed: 06/23/2023] Open
Abstract
Objectives To assess the readability, credibility, and accuracy of online information on chronic pain in Australia, Mexico, and Nepal. Methods We assessed Google-based websites and government health websites about chronic pain for readability (using the Flesch Kincaid Readability Ease tool), credibility (using the Journal of American Medical Association [JAMA] benchmark criteria and Health on the Net Code [HONcode]), and accuracy (using 3 core concepts of pain science education: (1) pain does not mean my body is damaged; (2) thoughts, emotions, and experiences affect pain; and (3) I can retrain my overactive pain system). Results We assessed 71 Google-based websites and 15 government websites. There were no significant between-country differences in chronic pain information retrieved through Google for readability, credibility, or accuracy. Based on readability scores, the websites were "fairly difficult to read," suitable for ages 15 to 17 years or grades 10 to 12 years. For credibility, less than 30% of all websites met the full JAMA criteria, and more than 60% were not HONcode certified. For accuracy, all 3 core concepts were present in less than 30% of websites. Moreover, we found that the Australian government websites have low readability but are credible, and the majority provided all 3 core concepts in pain science education. A single Mexican government website had low readability without any core concepts but was credible. Conclusion The readability, credibility, and accuracy of online information on chronic pain should be improved internationally to support facilitating better management of chronic pain.
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Affiliation(s)
- Ritu Basnet
- Scheer Memorial Adventist Hospital, Benepa, Nepal
| | - David Ruiz Mendez
- Iztacala Faculty of Superior Studies, National Autonomous University of México, Tlalnepantla de Baz, Mexico
| | - Isaías Lugo-González
- Iztacala Faculty of Superior Studies, National Autonomous University of México, Tlalnepantla de Baz, Mexico
| | - Edel O'Hagan
- Westmead Applied Research Centre, Faculty of Medicine and Health, The University of Sydney, Westmead, Australia
| | - Mary O'Keeffe
- School of Public Health, Institute for Musculoskeletal Health, University of Sydney, Sydney, Australia
| | - Saurab Sharma
- Department of Exercise Physiology, School of Health Sciences, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia
| | - Joshua W. Pate
- Graduate School of Health, University of Technology Sydney, Sydney, Australia
| | - David S. Kennedy
- Graduate School of Health, University of Technology Sydney, Sydney, Australia
- Motion and Mobility Research Laboratory, University of Victoria, Victoria, BC, Canada
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DuPont CM, Olmstead R, Reid MJ, Hamilton KR, Campbell CM, Finan PH, Sadeghi N, Castillo D, Irwin MR, Smith MT. A randomized, placebo-controlled, double-blinded mechanistic clinical trial using endotoxin to evaluate the relationship between insomnia, inflammation, and affective disturbance on pain in older adults: A protocol for the sleep and Healthy Aging Research for pain (SHARE-P) study. Brain Behav Immun Health 2023; 30:100642. [PMID: 37256193 PMCID: PMC10225887 DOI: 10.1016/j.bbih.2023.100642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 05/18/2023] [Indexed: 06/01/2023] Open
Abstract
Chronic pain is prevalent in older adults. Treatment, especially with opioids, is often ineffective and poses considerable negative consequences in this population. To improve treatment, it is important to understand why older adults are at a heightened risk for developing chronic pain. Insomnia is a major modifiable risk factor for chronic pain that is ubiquitous among older adults. Insomnia can also lead to heightened systemic inflammation and affective disturbance, both of which may further exacerbate pain conditions in older adults. Endotoxin exposure can be used as an experimental model of systemic inflammation and affective disturbance. The current study aims to understand how insomnia status and endotoxin-induced changes in inflammation and affect (increased negative affect and decreased positive affect) may interact to impact pain facilitatory and inhibitory processes in older adults. Longitudinal data will also assess how pain processing, affective, and inflammatory responses to endotoxin may predict the development of pain and/or depressive symptoms. The current study is a randomized, double-blinded, placebo-controlled, mechanistic clinical trial in men and women, with and without insomnia, aged 50 years and older. Participants were randomized to either 0.8ng/kg endotoxin injection or saline placebo injection. Daily diaries were used to collect variables related to sleep, mood, and pain at two-week intervals during baseline and 3-, 6-, 9-, and 12-months post-injection. Primary outcomes during the experimental phase include conditioned pain modulation, temporal summation, and affective pain modulation ∼5.5 hours after injection. Primary outcomes for longitudinal assessments are self-reported pain intensity and depressive symptoms. The current study uses endotoxin as an experimental model for pain. In doing so, it aims to extend the current literature by: (1) including older adults, (2) investigating insomnia as a potential risk factor for chronic pain, (3) evaluating the role of endotoxin-induced affective disturbances on pain sensitivity, and (4) assessing sex differences in endotoxin-induced hyperalgesia. Clinicaltrialsgov NCT03256760. Trial sponsor NIH R01AG057750-01.
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Affiliation(s)
- Caitlin M. DuPont
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - Richard Olmstead
- Department of Psychiatry and Biobehavioral Sciences, Cousins Center for Psychoneuroimmunology, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California Los Angeles (UCLA), Los Angeles, CA, USA
| | - Matthew J. Reid
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - Katrina R. Hamilton
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - Claudia M. Campbell
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - Patrick H. Finan
- University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Nina Sadeghi
- Department of Psychiatry and Biobehavioral Sciences, Cousins Center for Psychoneuroimmunology, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California Los Angeles (UCLA), Los Angeles, CA, USA
| | - Daisy Castillo
- Department of Psychiatry and Biobehavioral Sciences, Cousins Center for Psychoneuroimmunology, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California Los Angeles (UCLA), Los Angeles, CA, USA
| | - Michael R. Irwin
- Department of Psychiatry and Biobehavioral Sciences, Cousins Center for Psychoneuroimmunology, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California Los Angeles (UCLA), Los Angeles, CA, USA
| | - Michael T. Smith
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
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Jayaseelan DJ, Scalzitti DA, Courtney CA. Physical therapist perceptions and use of clinical pain mechanism assessment in the musculoskeletal setting: a survey analysis. BMC Musculoskelet Disord 2023; 24:509. [PMID: 37349782 DOI: 10.1186/s12891-023-06618-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 06/09/2023] [Indexed: 06/24/2023] Open
Abstract
BACKGROUND A mechanism-based approach to the evaluation and management of pain has been suggested across disciplines in contemporary research. However, the translation of pain mechanism assessment strategies in research to clinical practice is unclear. This study sought to explore perceptions and use of clinical pain mechanism assessment by physical therapists managing musculoskeletal pain. METHODS This was an electronic cross-sectional survey. After initial development, refinement, and piloting for comprehensiveness, comprehensibility and relevance, the survey was disseminated to members of the Academy of Orthopaedic Physical Therapy via email listserv. Data was maintained anonymously using the online database REDCap. Descriptive statistics and Spearman's correlations for non-parametric data were analyzed for frequencies and associations across variables. RESULTS In total, 148 respondents completed all aspects of the survey. Respondent age ranged from 26 to 73 years, with a mean (SD) of 43.9 (12.0). Most respondents (70.8%) reported performing clinical pain mechanism assessments at least 'sometimes'. A majority (80.4%) believed clinical pain mechanism assessments are useful in guiding management strategies while 79.8% reported specifically choosing interventions to alter aberrant pain mechanisms. The most commonly used pain severity, physical examination testing and questionnaires were the numeric pain rating scale, pressure pain thresholds and pain diagrams, respectively. However, the vast majority of instruments to clinically assess pain mechanisms were performed by a small proportion of respondents (< 30%). There were no significant correlations between age, years of experience, highest earned degree, completion of advanced training or specialist certification and testing frequency. CONCLUSION The evaluation of pain mechanisms involved in the pain experience is becoming common in research. The clinical application of pain mechanism assessment is unclear. Based on the results of this survey, physical therapists in the orthopedic setting believe pain mechanism assessment is useful, but data suggests it is infrequently performed. Additional research to uncover clinician motivation related to pain mechanism assessment is warranted.
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Affiliation(s)
- Dhinu J Jayaseelan
- Department of Health, Human Function, and Rehabilitation Sciences, The George Washington University, DC, Washington, USA.
| | - David A Scalzitti
- Department of Health, Human Function, and Rehabilitation Sciences, The George Washington University, DC, Washington, USA
| | - Carol A Courtney
- Department of Physical Therapy & Human Movement Sciences, Northwestern University, Chicago, IL, USA
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Cleary DR, Tan H, Ciacci J. Intradermal and Intramuscular Bupivacaine Reduces Opioid Use Following Noninstrumented Spine Surgery. World Neurosurg 2023; 170:e716-e723. [PMID: 36442775 DOI: 10.1016/j.wneu.2022.11.099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 11/21/2022] [Accepted: 11/22/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To evaluate the efficacy of intraoperative bupivacaine hydrochloride wound infiltration as an adjunct means of pain relief following noninstrumented posterior spine surgery. METHODS A retrospective cohort analysis was performed of all patients who underwent posterior spinal decompression surgery at the University of California, San Diego, and at the San Diego VA Medical Center between June 2020 and July 2021, following a change in practice to including bupivacaine infiltration at the end of the surgery. Patients were stratified into groups based on whether they received intrawound bupivacaine during surgery. Demographic and clinical data were extracted from the electronic health record. Postoperative opioid use, visual analog pain scores, heart rate, and blood pressure were compared. RESULTS The analysis included 43 patients; 21 received bupivacaine infiltration, and 22 did not. No complications were encountered in the perioperative period. Patients who received bupivacaine consumed significantly less opioids over the 72 hours following surgery, had slightly lower pain scores, and experienced slightly lower heart rates. No significant difference was found between groups with respect to systolic blood pressure, operative time, or length of hospital stay. CONCLUSIONS Intraoperative infiltration of the exposed paraspinous musculature and peri-incisional subdermal layer with bupivacaine significantly reduced postoperative opioid consumption for 72 hours after surgery and slightly reduced pain ratings and conferred superior heart rate control. This low-cost intervention produced significant patient benefit with minimal risk and no significant increase in surgical time or hospital stay.
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Affiliation(s)
- Daniel R Cleary
- Department of Neurosurgery, University of California, San Diego, San Diego, California, USA.
| | - Hao Tan
- Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon, USA
| | - Joseph Ciacci
- Department of Neurosurgery, University of California, San Diego, San Diego, California, USA
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Mechanisms of bone pain: Progress in research from bench to bedside. Bone Res 2022; 10:44. [PMID: 35668080 PMCID: PMC9170780 DOI: 10.1038/s41413-022-00217-w] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 04/29/2022] [Accepted: 05/09/2022] [Indexed: 12/27/2022] Open
Abstract
AbstractThe field of research on pain originating from various bone diseases is expanding rapidly, with new mechanisms and targets asserting both peripheral and central sites of action. The scope of research is broadening from bone biology to neuroscience, neuroendocrinology, and immunology. In particular, the roles of primary sensory neurons and non-neuronal cells in the peripheral tissues as important targets for bone pain treatment are under extensive investigation in both pre-clinical and clinical settings. An understanding of the peripheral mechanisms underlying pain conditions associated with various bone diseases will aid in the appropriate application and development of optimal strategies for not only managing bone pain symptoms but also improving bone repairing and remodeling, which potentially cures the underlying etiology for long-term functional recovery. In this review, we focus on advances in important preclinical studies of significant bone pain conditions in the past 5 years that indicated new peripheral neuronal and non-neuronal mechanisms, novel targets for potential clinical interventions, and future directions of research.
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Botulinum Toxin-A Injection in Chronic Pelvic Pain Syndrome Treatment: A Systematic Review and Pooled Meta-Analysis. Toxins (Basel) 2022; 14:toxins14010025. [PMID: 35051002 PMCID: PMC8780260 DOI: 10.3390/toxins14010025] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 12/17/2021] [Accepted: 12/27/2021] [Indexed: 12/24/2022] Open
Abstract
Introduction: Pain management of patients with chronic pelvic pain syndrome (CPPS) is challenging, because pain is often refractory to conventional treatments. Botulinum toxin A (BTX-A) may represent a promising therapeutic strategy for these patients. The aim of this systematic review was to investigate the role of BTX-A in CPPS treatment. Methods: We reviewed the literature for prospective studies evaluating the use of BTX-A in the treatment of CPPS. A comprehensive search in the PubMed, Scopus, Web of Science, and Cochrane Central Register of Controlled Trials databases was performed from English language articles published between January 2000 and October 2021. The primary outcome was to evaluate pain improvement in CPPS after BTX-A treatment. Pooled meta-analysis of the included studies, considering the effect of BTX-A on pain evaluated at last available follow-up compared to baseline values, was performed together with meta-regression analysis. Results: After screening 1001 records, 18 full-text manuscripts were selected, comprising 13 randomized clinical trials and five comparative studies. They covered overall 896 patients of both sexes and several subtype of CPPS (interstitial cystitis/bladder pain syndrome, chronic prostatitis/prostate pain syndrome, chronic scrotal pain, gynecological pelvic pain, myofascial pelvic pain). The clinical and methodological heterogeneity of studies included makes it difficult to do an overall estimation of the real effect of BTX-A on pain and other functional outcomes of various CPPS subtypes. However, considering pooled meta-analysis results, a benefit in pain relief was showed for BTX-A-treated patients both in the overall studies populations and in the overall cohorts of patients with CPP due to bladder, prostate, and gynecological origin. Conclusions: BTX-A could be an efficacious treatment for some specific CPPS subtypes. Higher level studies are needed to assess the efficacy and safety of BTX-A and provide objective indications for its use in CPPS management.
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Analgesia Effect of Verum and Sham Acupuncture Treatments in Primary Dysmenorrhea: A MRI Pilot Study. J Pers Med 2021; 11:jpm11121244. [PMID: 34945716 PMCID: PMC8706482 DOI: 10.3390/jpm11121244] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 11/19/2021] [Accepted: 11/22/2021] [Indexed: 11/17/2022] Open
Abstract
Acupuncture is an alternative treatment for primary dysmenorrhea (PDM). However, mechanisms by which acupuncture exerts its analgesic properties are still unclear. This study aimed to explore the cerebral blood flow (CBF) response to verum and sham acupuncture treatments, and further investigate whether pre-treatment CBF is capable of assessing symptom changes after interventions. A total of 11 PDM patients in the verum group and 12 patients in the sham group participated in this study. Pain rating index (PRI), CBF, and gonadal hormone levels were acquired before and after 8-week treatments. Both verum and sham acupuncture treatments exert its analgesic effect on PDM after intervention as PRI reduced (p < 0.05). Blood gonadal levels were not significantly different after acupuncture in both groups (all p > 0.05). In the verum group, intervention-related decreases in CBF were observed in the right dorsal anterior cingulate cortex. In the sham group, regions identified as showing reductions in CBF after acupuncture included the left ventromedial prefrontal cortex, left caudate, and left insula. Patients with higher baseline CBF in the left precuneus and right hippocampus were accompanied with worse treatment response to acupuncture intervention. Mechanisms of verum and sham acupuncture treatments are dissimilar as manifested by different brain responses.
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11
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Mohammadpour M, Heirani M, Khorrami-Nejad M, Ambrósio R. Update on Pain Management After Advanced Surface Ablation. J Refract Surg 2021; 37:782-790. [PMID: 34756143 DOI: 10.3928/1081597x-20210809-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To provide an update for postoperative pain control strategies to help ophthalmic surgeons establish a more effective management plan for patients who underwent advanced surface ablation surgeries. METHODS Google Scholar, Scopus, ScienceDirect, and PubMed were the main resources used to search the medical literature. RESULTS The postoperative cornea's healing process is accompanied by intense pain as the chief complaint in the first days after the operation. Several strategies were developed to relieve postoperative pain after surface ablation procedures. These strategies included different preoperative, intraoperative, and postoperative methods. Considering the preoperative demographic and emotional factors, underlying dry eye, alternative epithelial removal techniques, bandage contact lenses, and topical or oral therapeutic agents are some examples of postoperative pain treatments after surface ablation procedures. CONCLUSIONS The current review revealed that despite the development of numerous protocols to relieve postoperative pain following surface ablations, the best approach could be a combination of different strategies. In practice, no validated and standardized strategy is available for total elimination of postoperative pain following advanced surface ablation surgeries. [J Refract Surg. 2021;37(11):782-790.].
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Wang Y, Peng Y, Zhang C, Zhou X. Astrocyte-neuron lactate transport in the ACC contributes to the occurrence of long-lasting inflammatory pain in male mice. Neurosci Lett 2021; 764:136205. [PMID: 34478818 DOI: 10.1016/j.neulet.2021.136205] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 08/24/2021] [Accepted: 08/29/2021] [Indexed: 12/20/2022]
Abstract
Lactate transport is an important means of communication between astrocytes and neurons and is implicated in a variety of neurobiological processes. However, the connection between astrocyte-neuron lactate transport and nociceptive modulation has not been well established. Here, we found that Complete Freund's adjuvant (CFA)-induced inflammation pain leads to a significant increase in extracellular lactate levels in the anterior cingulate cortex (ACC). Inhibition of glycogenolysis and lactate release in the ACC disrupted the persistent, but not acute, inflammation pain induced by CFA, and this effect was reversed by exogenous L-lactate administration. Knocking down the expression of lactate transporters (MCT1, MCT4, or MCT2) also disrupted the long lasting inflammation pain induced by CFA. Moreover, glycogenolysis in the ACC is critical for the induction of molecular changes related to neuronal plasticity, including the induction of phospho- (p-) ERK, p-CREB, and Fos. Taken together, our findings indicate that astrocyte-neuron lactate transport in the ACC is critical for the occurrence of persistent inflammation pain, suggesting a novel mechanism underlying chronic pain.
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Affiliation(s)
- Yin Wang
- Department of Anesthesiology, Taizhou People's Hospital, Taizhou, Jiangsu, China
| | - Yunan Peng
- Department of Anesthesiology, Affiliated Drum Tower Hospital of Medical School of Nanjing University, Nanjing, Jiangsu, China
| | - Chenjing Zhang
- Department of Anesthesiology, Taizhou People's Hospital, Taizhou, Jiangsu, China
| | - Xuelong Zhou
- Department of Anesthesiology and Perioperative Medicine, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China.
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Parsons BA, Baranowski AP, Berghmans B, Borovicka J, Cottrell AM, Dinis-Oliveira P, Elneil S, Hughes J, Messelink BEJ, de C Williams AC, Abreu-Mendes P, Zumstein V, Engeler DS. Management of chronic primary pelvic pain syndromes. BJU Int 2021; 129:572-581. [PMID: 34617386 DOI: 10.1111/bju.15609] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Management of chronic pelvic pain (CPP) remains a huge challenge for care providers and a major burden for healthcare systems. Treating chronic pain that has no obvious cause warrants an understanding of the difficulties in managing these conditions. Chronic pain has recently been accepted as a disease in its own right by the World Health Organization, with chronic pain without obvious cause being classified as chronic primary pain. Despite innumerable treatments that have been proposed and tried to date for CPP, unimodal therapeutic options are mostly unsuccessful, especially in unselected individuals. In contrast, individualised multimodal management of CPP seems the most promising approach and may lead to an acceptable situation for a large proportion of patients. In the present review, the interdisciplinary and interprofessional European Association of Urology Chronic Pelvic Pain Guideline Group gives a contemporary overview of the most important concepts to successfully diagnose and treat this challenging disease.
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Affiliation(s)
| | - Andrew P Baranowski
- National Hospital for Neurology and Neurosurgery, University College London Hospitals Foundation Trust, University College London, London, UK
| | - Bary Berghmans
- Pelvic Care Centre Maastricht, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Jan Borovicka
- Department of Gastroenterology/Hepatology, School of Medicine, Cantonal Hospital of St. Gallen, University of St. Gallen, St. Gallen, Switzerland
| | | | - Paulo Dinis-Oliveira
- Department of Urology, University of Porto Faculty of Medicine, Hospital de Sao Joao, Porto, Portugal
| | - Sohier Elneil
- National Hospital for Neurology and Neurosurgery, University College Hospital, London, UK
| | - John Hughes
- The James Cook University Hospital, Middlesbrough, UK
| | - Bert E J Messelink
- Department of Urology, Medical Centre Leeuwarden, Leeuwarden, The Netherlands
| | - Amanda C de C Williams
- Research Department of Clinical, Educational & Health Psychology, University College London, London, UK
| | - Pedro Abreu-Mendes
- Department of Urology, University of Porto Faculty of Medicine, Hospital de Sao Joao, Porto, Portugal
| | - Valentin Zumstein
- Department of Urology, School of Medicine, Cantonal Hospital of St. Gallen, University of St. Gallen, St. Gallen, Switzerland
| | - Daniel S Engeler
- Department of Urology, School of Medicine, Cantonal Hospital of St. Gallen, University of St. Gallen, St. Gallen, Switzerland
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Khera T, Rangasamy V. Cognition and Pain: A Review. Front Psychol 2021; 12:673962. [PMID: 34093370 PMCID: PMC8175647 DOI: 10.3389/fpsyg.2021.673962] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 04/26/2021] [Indexed: 01/14/2023] Open
Abstract
Cognition is defined as the brain's ability to acquire, process, store, and retrieve information. Pain has been described as an unpleasant sensory or emotional experience, and for experiencing pain consciously, cognitive processing becomes imperative. Moreover, evaluation of pain strongly depends on cognition as it requires learning and recall of previous experiences. There could be a possible close link between neural systems involved in cognition and pain processing, and studies have reported an association between pain and cognitive impairment. In this narrative review, we explore the available evidence that has investigated cognitive changes associated with pain. We also examine the anatomical, biochemical, and molecular association of pain and neuro-cognition. Additionally, we focus on the cognitive impairment caused by analgesic medications. There is a need to improve our understanding of pathophysiology and cognitive impairment mechanisms associated with chronic pain and its treatment. This area provides a diverse opportunity for grounding future research, aiding institution of timely interventions to prevent chronic pain and associated cognitive decline, ultimately improving patient care.
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Affiliation(s)
- Tanvi Khera
- Department of Anesthesia Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Valluvan Rangasamy
- Department of Anesthesia Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
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Safety and efficacy of an equimolar mixture of oxygen and nitrous oxide: a randomized controlled trial in patients with peripheral neuropathic pain. Pain 2021; 162:1104-1115. [PMID: 33044394 DOI: 10.1097/j.pain.0000000000002109] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 10/05/2020] [Indexed: 11/25/2022]
Abstract
ABSTRACT Nitrous oxide (N2O) is an odorless and colorless gas routinely used as an adjuvant of anesthesia and for short-duration analgesia in various clinical settings mostly in the form of an N2O/O2 50%-50% equimolar mixture (EMONO). Experimental studies have suggested that EMONO could also induce long-lasting analgesic effects related to the blockade of N-methyl-D-aspartate receptors. We designed the first international multicenter proof of concept randomized, placebo-controlled study to assess the efficacy and safety of a 1-hour administration of EMONO or placebo (medical air) on 3 consecutive days up to 1 month after the last administration in patients with chronic peripheral neuropathic pain. A total of 240 patients were recruited in 22 centers in France and Germany and randomly assigned to 1 study group (120 per group). Average pain intensity (primary outcome), neuropathic pain characteristics (Neuropathic Pain Symptom Inventory), Patient Global Impression of Change, anxiety, depression, and quality of life were systematically assessed before and after treatment. The changes in average pain intensity between baseline and 7 days after the last administration were not significantly different between the 2 groups. However, evoked pain intensity (predefined secondary endpoint) and Patient Global Impression of Change (exploratory endpoint) were significantly improved in the EMONO group, and these effects were maintained up to 4 weeks after the last treatment administration. Mostly transient side effects were reported during the treatment administration. These encouraging results provide a basis for further investigation of the long-term analgesic effects of EMONO in patients with neuropathic pain.
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Xing M, Kallogjeri D, Piccirillo JF. Investigating the Impact of Cognitive Training for Individuals With Bothersome Tinnitus: A Randomized Controlled Trial. Otolaryngol Head Neck Surg 2021; 165:854-861. [PMID: 33650921 DOI: 10.1177/0194599821994742] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To evaluate the effectiveness of cognitive training in improving tinnitus bother and to identify predictors of patient response. STUDY DESIGN Prospective open-label randomized controlled trial. SETTING Online. METHODS Participants were adults with subjective idiopathic nonpulsatile tinnitus causing significant tinnitus-related distress. The intervention group trained by using auditory-intensive exercises for 20 minutes per day, 5 days per week, for 8 weeks. The active control group trained on the same schedule with non-auditory intensive games. Surveys were completed at baseline, 8 weeks, and 12 weeks. RESULTS A total of 64 participants completed the study. The median age was 63 years (range, 25-69) in the intervention group and 61 years (34-68) in the control group. Mixed model analysis revealed that within-subject change in Tinnitus Functional Index in the intervention group was not different than the control group, with marginal mean differences (95% CI): 0.24 (-11.20 to 10.7) and 2.17 (-8.50 to 12.83) at 8 weeks and 2.33 (-8.6 to 13.3) and 3.36 (-7.91 to 14.6) at 12 weeks, respectively. When the 2 study groups were compared, the control group had higher Tinnitus Functional Index scores than the intervention group by 10.5 points at baseline (95% CI, -0.92 to 29.89), 8.1 at 8 weeks (95% CI, -3.27 to 19.42), and 9.4 at 12 weeks (95% CI, -2.45 to 21.34). CONCLUSION Auditory-intensive cognitive training was not associated with changes in self-reported tinnitus bother. Given the potential for neuroplasticity to affect tinnitus, we believe that future studies on cognitive training for tinnitus remain relevant.
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Affiliation(s)
- Maggie Xing
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St Louis, Missouri, USA
| | - Dorina Kallogjeri
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St Louis, Missouri, USA
| | - Jay F Piccirillo
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St Louis, Missouri, USA
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Parsons BA, Goonewardene S, Dabestani S, Pacheco-Figueiredo L, Yuan Y, Zumstein V, Cottrell AM, Borovicka J, Dinis-Oliveira P, Berghmans B, Elneil S, Hughes J, Messelink BEJ, de C Williams AC, Baranowski AP, Engeler DS. The Benefits and Harms of Botulinum Toxin-A in the Treatment of Chronic Pelvic Pain Syndromes: A Systematic Review by the European Association of Urology Chronic Pelvic Pain Panel. Eur Urol Focus 2021; 8:320-338. [PMID: 33526405 DOI: 10.1016/j.euf.2021.01.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 12/10/2020] [Accepted: 01/08/2021] [Indexed: 12/20/2022]
Abstract
CONTEXT Patients with chronic pelvic pain syndrome (CPPS) may have pain refractory to conventional management strategies. Botulinum toxin A (BTX-A) is a potential therapeutic option. OBJECTIVE To evaluate the benefits and harms of BTX-A injections in the treatment of CPPS. EVIDENCE ACQUISITION A systematic review of the use of BTX-A in the treatment of CPPS was conducted (PROSPERO-ID: 162416). Comprehensive searches of EMBASE, PUBMED, Medline, and SCOPUS were performed for publications between January 1996 and May 2020. Identified studies were screened and selected studies assessed for quality prior to data extraction. The primary outcomes were improvement in pain and adverse events following treatment. Secondary outcomes included quality of life, global response assessment, sexual function, bowel function, and bladder function. EVIDENCE SYNTHESIS After screening 1001 abstracts, 16 studies including 11 randomised controlled trials were identified, enrolling 858 patients and covering a range of CPPS subtypes. Most studies showed high risks of bias and confounding across all domains. A narrative synthesis was performed as heterogeneity of included studies precluded a meta-analysis and calculation of pooled effect estimates of measured outcomes. BTX-A reduced pain significantly in patients with bladder pain syndrome in two studies and in patients with prostate pain syndrome in one study, but no included studies showed benefit for patients with gynaecological pelvic pain. Adverse event reporting was variable and generally poor, but no serious adverse events were described. CONCLUSIONS Beneficial effects of BTX-A on pain, quality of life, and functional symptoms were seen in patients with certain CPPS subtypes, but the current evidence level is too weak to allow recommendations about BTX-A use for treating CPPS. PATIENT SUMMARY Botulinum toxin A is used to treat different pain disorders, but current studies are of insufficient quality to determine whether it reduces pain and improves quality of life in patients with chronic pelvic pain. Further research is needed.
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Affiliation(s)
| | | | - Saeed Dabestani
- Department of Clinical Sciences Lund, Lund University, Skane University Hospital, Lund, Sweden
| | - Luis Pacheco-Figueiredo
- Department of Urology, Hospital de Sao Joao, University of Porto Faculty of Medicine, Porto, Portugal
| | - Yuhong Yuan
- Department of Medicine, McMaster University, Hamilton, Canada
| | | | | | | | - Paulo Dinis-Oliveira
- Department of Urology, Hospital de Sao Joao, University of Porto Faculty of Medicine, Porto, Portugal
| | - Bary Berghmans
- Pelvic Care Centre Maastricht, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Sohier Elneil
- University College Hospital and the Hospital for Neurology and Neurosurgery, London, UK
| | - John Hughes
- The James Cook University Hospital, Middlesbrough, UK
| | - Bert E J Messelink
- Department of Urology, Medical Centre Leeuwarden, Leeuwarden, The Netherlands
| | - Amanda C de C Williams
- Research Department of Clinical, Educational & Health Psychology, University College London, London, UK
| | - Andrew P Baranowski
- University College London and the National Hospital for Neurology and Neurosurgery, University College London Hospitals Foundation Trust, London, UK
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Comparing the Efficacy of Combined Treatment with Medial Branch Block and Facet Joint Injection in Axial Low Back Pain. Pain Res Manag 2021; 2021:1343891. [PMID: 33505542 PMCID: PMC7808813 DOI: 10.1155/2021/1343891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 11/15/2020] [Accepted: 12/02/2020] [Indexed: 11/18/2022]
Abstract
Introduction Medial branch nerve block (MBB) and facet joint injections (FJIs) can be used to manage axial low back pain. Although there have been studies comparing the MBB and FJI effects, a few studies have compared the therapeutic effects of both interventions combined with each separate intervention. This study aimed to compare the pain relief effect of MBB, FJI, and combined treatment with MBB and FJI in patients with axial low back pain. Methods We conducted a retrospective review of patients with axial low back pain who had chart records of the Numeric Rating Scale (NRS) and Oswestry Disability Index (ODI) scores measured before treatment and within 6 weeks after treatment. The proportion of patients with successful responses (>30%) was calculated and is presented with Wald confidence intervals. Results We included 66 patients (33, 17, and 16 patients in the MBB, FJI, and combined treatment with MBB and FJI groups). All the patient groups showed significant posttreatment improvements in the NRS [(proportion >30% decrease: MBB 24.2% (9.6–38.9), FJI 29.4% (7.8–51.1), and MBB + FJI 25.0% (3.8–46.2)] scores and the ODI [proportion >30% decrease: MBB 39.4% (22.7–56.1), FJI 23.5% (3.4–43.7), and MBB + FJI 37.5% (13.8–61.2)] scores. Furthermore, there was no significant among-group difference in the ODI and NRS scores. Conclusion MBB, FJI, and combined treatment with MBB and FJI can reduce axial low back pain and improve secondary functional degradation. Although combined treatment with MBB and FJI required a longer intervention time, it did not have a pain relief effect superior to that of MBB or FJI alone.
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Richard SA, Kampo S, Sackey M, Hechavarria ME, Buunaaim ADB. The Pivotal Potentials of Scorpion Buthus Martensii Karsch-Analgesic-Antitumor Peptide in Pain Management and Cancer. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2020; 2020:4234273. [PMID: 33178316 PMCID: PMC7647755 DOI: 10.1155/2020/4234273] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 09/13/2020] [Accepted: 10/20/2020] [Indexed: 01/26/2023]
Abstract
Scorpion Buthus martensii Karsch -analgesic-antitumor peptide (BmK AGAP) has been used to treat diseases like tetanus, tuberculosis, apoplexy, epilepsy, spasm, migraine headaches, rheumatic pain, and cancer in China. AGAP is a distinctive long-chain scorpion toxin with a molecular mass of 7142 Da and composed of 66 amino acids cross-linked by four disulfide bridges. Voltage-gated sodium channels (VGSCs) are present in excitable membranes and partakes in essential roles in action potentials generation as compared to the significant function of voltage-gated calcium channels (VGCCs). A total of nine genes (Nav1.1-Nav1.9) have been recognized to encode practical sodium channel isoforms. Nav1.3, Nav1.7, Nav1.8, and Nav1.9 have been recognized as potential targets for analgesics. Nav1.8 and Nav1.9 are associated with nociception initiated by inflammation signals in the neuronal pain pathway, while Nav1.8 is fundamental for neuropathic pain at low temperatures. AGAP has a sturdy inhibitory influence on both viscera and soma pain. AGAP potentiates the effects of MAPK inhibitors on neuropathic as well as inflammation-associated pain. AGAP downregulates the secretion of phosphorylated p38, phosphorylated JNK, and phosphorylated ERK 1/2 in vitro. AGAP has an analgesic activity which may be an effective therapeutic agent for pain management because of its downregulation of PTX3 via NF-κB and Wnt/beta-catenin signaling pathway. In cancers like colon cancer, breast cancer, lymphoma, and glioma, rAGAP was capable of blocking the proliferation. Thus, AGAP is a promising therapy for these tumors. Nevertheless, research is needed with other tumors.
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Affiliation(s)
- Seidu A. Richard
- Department of Medicine, Princefield University, P.O. Box MA128, Ho, Ghana
| | - Sylvanus Kampo
- Department of Anesthesia and Critical Care, School of Medicine, University of Health and Allied Sciences, Ho, Ghana
| | - Marian Sackey
- Department of Pharmacy, Ho Teaching Hospital, P.O. Box MA-374, Ho, Ghana
| | | | - Alexis D. B. Buunaaim
- Department of Surgery, School of Medicine and Health Science, University for Development Studies, Tamale, Ghana
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Roubaud MS. Targeted Muscle Reinnervation in the Oncologic Population: A Literature Review and Current Practice. CURRENT SURGERY REPORTS 2020. [DOI: 10.1007/s40137-020-00266-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Zibura AE, Salmon JH, Belda Lopez B, X Lascelles BD, Westermeyer HD. Glaucoma-associated pain results in mechanical sensitivity changes in dogs: A pilot study. Vet Ophthalmol 2020; 24 Suppl 1:116-124. [PMID: 32608141 DOI: 10.1111/vop.12800] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 06/04/2020] [Accepted: 06/05/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE To explore the effects of chronic, uncontrolled glaucoma on pressure sensitivity in dogs before and after enucleation of the painful globe. METHODS Client-owned dogs undergoing enucleation for chronic glaucoma with no other sources of pain were enrolled. Normal dogs of similar breeds and skull morphology were enrolled as controls. Craniofacial ratio (CFR) and relative palpebral fissure width (RPFW) were assessed in all patients. Serial mechanical quantitative sensory testing (QST) was performed the day before surgery, and 14, 30, 60, and 120 days after surgery. QST consisted of electronic Von Frey (eVF), and blunt algometry (BA) performed above and below the nonglaucomatous eye, the metacarpus, and metatarsus. Cochet-Bonnet esthesiometry (CB) was also performed on the remaining eye. RESULTS Twelve dogs (6 per group) were included. Compared to baseline values, sensitivity tended to decrease over time (increased thresholds) in treatment dogs while it stayed constant or increased slightly in control dogs. The difference in change from baseline sensitivity between control and treatment groups was significant at day 120 using BA at supraorbital (P = .0153), infraorbital (P = .0209), and metacarpal sites (P = .007) and overall (P = .0470). This divergence was also significant using CB (P = .0470) on the opposite cornea. As patient CFR and RPFWV increased, both eVF (P = .005-.023) and BA (P = .004-.041) increased. CONCLUSIONS Sensitivity to mechanical stimuli decreased both locally and at remote sites in dogs following enucleation for painful chronic glaucoma. Cranial conformation is associated with differences in sensitivity.
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Affiliation(s)
- Ashley E Zibura
- Comparative Ophthalmology, Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, USA
| | - Jacklyn H Salmon
- Comparative Ophthalmology, Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, USA
| | - Beatriz Belda Lopez
- Small Animal Surgery, Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, USA.,Translational Research in Pain Program, Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, USA
| | - B Duncan X Lascelles
- Small Animal Surgery, Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, USA.,Translational Research in Pain Program, Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, USA.,Comparative Pain Research and Education Center, North Carolina State University, Raleigh, NC, USA
| | - Hans D Westermeyer
- Comparative Ophthalmology, Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, USA
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Esposito MF, Malayil R, Hanes M, Deer T. Unique Characteristics of the Dorsal Root Ganglion as a Target for Neuromodulation. PAIN MEDICINE 2020; 20:S23-S30. [PMID: 31152179 PMCID: PMC6544557 DOI: 10.1093/pm/pnz012] [Citation(s) in RCA: 114] [Impact Index Per Article: 28.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Objective The dorsal root ganglion (DRG) is a novel target for neuromodulation, and DRG stimulation is proving to be a viable option in the treatment of chronic intractable neuropathic pain. Although the overall principle of conventional spinal cord stimulation (SCS) and DRG stimulation—in which an electric field is applied to a neural target with the intent of affecting neural pathways to decrease pain perception—is similar, there are significant differences in the anatomy and physiology of the DRG that make it an ideal target for neuromodulation and may account for the superior outcomes observed in the treatment of certain chronic neuropathic pain states. This review highlights the anatomy of the DRG, its function in maintaining homeostasis and its role in neuropathic pain, and the unique value of DRG as a target in neuromodulation for pain. Methods A narrative literature review was performed. Results Overall, the DRG is a critical structure in sensory transduction and modulation, including pain transmission and the maintenance of persistent neuropathic pain states. Unique characteristics including selective somatic organization, specialized membrane characteristics, and accessible and consistent location make the DRG an ideal target for neuromodulation. Because DRG stimulation directly recruits the somata of primary sensory neurons and harnesses the filtering capacity of the pseudounipolar neural architecture, it is differentiated from SCS, peripheral nerve stimulation, and other neuromodulation options. Conclusions There are several advantages to targeting the DRG, including lower energy usage, more focused and posture-independent stimulation, reduced paresthesia, and improved clinical outcomes.
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Affiliation(s)
| | - Rudy Malayil
- St. Mary's Pain Relief Specialists, Huntington, West Virginia
| | | | - Timothy Deer
- The Spine and Nerve Center of the Virginias, Charleston, West Virginia, USA
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Zink PJ, Philip BA. Cortical Plasticity in Rehabilitation for Upper Extremity Peripheral Nerve Injury: A Scoping Review. Am J Occup Ther 2020; 74:7401205030p1-7401205030p15. [PMID: 32078514 DOI: 10.5014/ajot.2020.036665] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
IMPORTANCE Poor outcomes after upper extremity peripheral nerve injury (PNI) may arise, in part, from the challenges and complexities of cortical plasticity. Occupational therapy practitioners need to understand how the brain changes after peripheral injury and how principles of cortical plasticity can be applied to improve rehabilitation for clients with PNI. OBJECTIVE To identify the mechanisms of cortical plasticity after PNI and describe how cortical plasticity can contribute to rehabilitation. DATA SOURCES PubMed and Embase (1900-2017) were searched for articles that addressed either (1) the relationship between PNI and cortical plasticity or (2) rehabilitative interventions based on cortical plastic changes after PNI. Study Selection and Data Collectio : PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed. Articles were selected if they addressed all of the following concepts: human PNI, cortical plasticity, and rehabilitation. Phantom limb pain and sensation were excluded. FINDINGS Sixty-three articles met the study criteria. The most common evidence level was Level V (46%). We identified four commonly studied mechanisms of cortical plasticity after PNI and the functional implications for each. We found seven rehabilitative interventions based on cortical plasticity: traditional sensory reeducation, activity-based sensory reeducation, selective deafferentation, cross-modal sensory substitution, mirror therapy, mental motor imagery, and action observation with simultaneous peripheral nerve stimulation. CONCLUSION AND RELEVANCE The seven interventions ranged from theoretically well justified (traditional and activity-based sensory reeducation) to unjustified (selective deafferentation). Overall, articles were heterogeneous and of low quality, and future research should prioritize randomized controlled trials for specific neuropathies, interventions, or cortical plasticity mechanisms. WHAT THIS ARTICLE ADDS This article reviews current knowledge about how the brain changes after PNI and how occupational therapy practitioners can take advantage of those changes for rehabilitation.
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Affiliation(s)
- Patrick J Zink
- Patrick J. Zink, MSOT, is Occupational Therapist, Select Physical Therapy, Kansas City, MO. At the time of the study, he was Student, Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO
| | - Benjamin A Philip
- Benjamin A. Philip, PhD, is Assistant Professor, Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO;
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Prophylactic Regenerative Peripheral Nerve Interfaces to Prevent Postamputation Pain. Plast Reconstr Surg 2019; 144:421e-430e. [DOI: 10.1097/prs.0000000000005922] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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Ramjeeawon A, Choy E. Neuropathic-like pain in psoriatic arthritis: evidence of abnormal pain processing. Clin Rheumatol 2019; 38:3153-3159. [PMID: 31325065 PMCID: PMC6825028 DOI: 10.1007/s10067-019-04656-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 06/12/2019] [Accepted: 06/20/2019] [Indexed: 01/28/2023]
Abstract
OBJECTIVES The primary objective was to investigate the prevalence of neuropathic-like pain in patients with psoriatic arthritis (PsA). Secondary outcomes were to investigate whether mood, fatigue, pain, disease severity and fibromyalgia are associated with neuropathic-like pain in PsA patients. METHODS PsA patients were assessed for fatigue, mood, pain, disease activity and fibromyalgia using questionnaires. Neuropathic-like pain was assessed by PainDetect. RESULTS Sixty-four patients with PsA were recruited from the Rheumatology Outpatient Department. Of the 64 patients recruited, 26.6% had 'likely neuropathic pain' and 21.9% had 'possible neuropathic-like pain' according to the PainDetect questionnaire. Patients with 'likely neuropathic pain' had higher disease activity, health assessment questionnaire, patient global self-assessment score, tender and swollen joint counts, dactylitis, enthesitis, pain severity and interference with day-to-day activities, fatigue severity and impact, fibromyalgia, anxiety and depression than 'unlikely neuropathic pain' patients (p < 0.05). PainDetect score correlated with measures of disease activity, fatigue, depression, anxiety, Widespread Pain Index and Symptom Severity Scale (all p < 0.05). Most patients (71%) with neuropathic-like pain fulfilled American College of Rheumatology 2010 fibromyalgia criteria. Patients with 'possible neuropathic-like pain' had scores between patients with 'likely neuropathic pain' and 'unlikely neuropathic pain'. CONCLUSION Neuropathic-like pain as evidence of abnormal pain processing is common in patients with PsA. It is associated with higher disease activity and fibromyalgia. A significant proportion of patients had 'possible neuropathic-like' pain with intermediate disease and symptom score suggesting neuropathic-like pain as evidence of abnormal pain processing is a continuum rather than concurrent fibromyalgia. Key Points • Neuropathic pain is prevalent in psoriatic arthritis. • Higher levels of pain, disease activity, fatigue, depression, anxiety and comorbidities in Psoriatic arthritis. • Increased pain severity is associated with increased disease activity, fatigue, depression and anxiety.
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Affiliation(s)
| | - Ernest Choy
- School of Medicine, Cardiff University, Cardiff, UK. .,CREATE Centre, Section of Rheumatology, Division of Infection and Immunity, Cardiff University, Tenovus Building, Heath Park Campus, Cardiff, CF14 4XN, UK.
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The Association between Preoperative Dry Eye Symptoms and Postoperative Discomfort in Patients Underwent Photorefractive Keratectomy. J Ophthalmol 2019; 2019:7029858. [PMID: 31275633 PMCID: PMC6589206 DOI: 10.1155/2019/7029858] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 01/05/2019] [Accepted: 01/22/2019] [Indexed: 11/18/2022] Open
Abstract
Purpose To investigate the association between preoperative dry eye symptoms on postoperative pain and discomfort after photorefractive keratectomy (PRK). Methods A retrospective case series of 151 consecutive patients, who underwent myopic PRK in both eyes between 5/2016 and 5/2017. Patients with positive dry eye disease (DED) signs on clinical examination or with known DED were excluded. Patients underwent a subjective evaluation for dry eye symptoms using ocular surface disease index (OSDI) and modified standard patient evaluation of eye dryness (SPEED) questionnaires. One day postoperatively, the patients were evaluated again by a questionnaire of pain, discomfort, photophobia, foreign body sensation, satisfaction with vision, and frequency of usage of anesthetic drops. Results Fifty-two patients had any preoperative dry eye symptoms (OSDI score > 0) compared to 99 nonsymptomatic patients (OSDI score of 0). Postoperatively, the symptomatic dry eye patients suffered significantly more pain than the nondry eye patients (p=0.02). Thirteen patients had a cumulated modified SPEED score >4 (moderate to severe) in comparison to 138 patients with score of 0-4 (non to mild). Patients with moderate to severe preoperative symptoms suffered more pain (p=0.006), photophobia (p=0.005), and epiphora (p=0.03). No statistically significant difference was seen in postoperative subjective visual quality (p=0.82) between the two groups. Conclusion Preoperative dry eye symptoms may be associated with postoperative pain, epiphora, and photophobia and thus influence negatively on patient satisfaction with this procedure.
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Carvajal G, Rocha A, Dupoiron D. Multimodal intrathecal therapy for phantom limb pain. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2019. [DOI: 10.1097/cj9.0000000000000106] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Al-Shamlan F, El-Hashim AZ. Bradykinin sensitizes the cough reflex via a B 2 receptor dependent activation of TRPV1 and TRPA1 channels through metabolites of cyclooxygenase and 12-lipoxygenase. Respir Res 2019; 20:110. [PMID: 31170972 PMCID: PMC6551914 DOI: 10.1186/s12931-019-1060-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 04/28/2019] [Indexed: 01/10/2023] Open
Abstract
Background Inhaled bradykinin (BK) has been reported to both sensitize and induce cough but whether BK can centrally sensitize the cough reflex is not fully established. In this study, using a conscious guinea-pig model of cough, we investigated the role of BK in the central sensitization of the cough reflex and in airway obstruction. Methods Drugs were administered, to guinea pigs, by the intracerebroventricular (i.c.v.) route. Aerosolized citric acid (0.2 M) was used to induce cough in a whole-body plethysmograph box, following i.c.v. infusion of drugs. An automated analyser recorded both cough and airway obstruction simultaneously. Results BK, administered by the i.c.v. route, dose-dependently enhanced the citric acid-induced cough and airway obstruction. This effect was inhibited following i.c.v. pretreatment with a B2 receptor antagonist, TRPV1 and TRPA1 channels antagonists and cyclooxygenase (COX) and 12-lipoxygenase (12-LOX) inhibitors. Furthermore, co-administration of submaximal doses of the TRPV1 and TRPA1 antagonists or the COX and 12-LOX inhibitors resulted in a greater inhibition of both cough reflex and airway obstruction. Conclusions Our findings show that central BK administration sensitizes cough and enhances airway obstruction via a B2 receptor/TRPV1 and/or TRPA1 channels which are coupled via metabolites of COX and/or 12-LOX enzymes. In addition, combined blockade of TRPV1 and TRPA1 or COX and 12-LOX resulted in a greater inhibitory effect of both cough and airway obstruction. These results indicate that central B2 receptors, TRPV1/TRPA1 channels and COX/12-LOX enzymes may represent potential therapeutic targets for the treatment of cough hypersensitivity. Graphical abstract ![]()
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Affiliation(s)
- Fajer Al-Shamlan
- Department of Pharmacology and Therapeutics, Faculty of Pharmacy, Kuwait University, P.O. BOX 24923, 13110, Safat, Kuwait
| | - Ahmed Z El-Hashim
- Department of Pharmacology and Therapeutics, Faculty of Pharmacy, Kuwait University, P.O. BOX 24923, 13110, Safat, Kuwait.
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Knezevic NN, Aijaz T, Candido KD, Kovaleva S, Lissounov A, Knezevic I. The Effect of Once-Daily Gabapentin Extended Release Formulation in Patients With Postamputation Pain. Front Pharmacol 2019; 10:504. [PMID: 31156433 PMCID: PMC6529536 DOI: 10.3389/fphar.2019.00504] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Accepted: 04/23/2019] [Indexed: 12/31/2022] Open
Abstract
Objectives To compare gabapentin extended-release, a gastro-retentive formulation, in relieving postamputation pain among gabapentin-experienced and gabapentin-naïve patients. Design Open-labeled pilot study. Subjects Sixteen patients with postamputation pain (8 patients in the gabapentin-experienced and 8 patients in the gabapentin-naïve groups). Methods Patients were started on gabapentin extended-release and were followed up for 8 weeks. Patients reported their pain severity during rest and movement using a numeric rating scale (NRS), interference of pain with daily activities using the modified brief pain inventory (MBPI) questionnaire, and treatment satisfaction using the treatment satisfaction questionnaire for medication (TSQM). Results Patients from both gabapentin-experienced and gabapentin-naïve groups achieved a significant and sustainable pain relief over the course of therapy. The pain scores at rest decreased in both gabapentin-experienced and gabapentin-naïve groups from 5.88 ± 1.36 and 4.88 ± 2.95 to 1.88 ± 0.99 and 1.38 ± 1.51, respectively. An average percent of pain relief with gabapentin extended-release was noted to be significant (p < 0.01) after 8 weeks of therapy among gabapentin-experienced (81.25 ± 16.42%) and gabapentin-naïve groups (85 ± 17.73%) when compared to baseline for gabapentin-experienced (31.25 ± 29%) and gabapentin-naïve groups (36.25 ± 34.2%), respectively. Gabapentin-experienced and gabapentin-naïve groups had no significant difference in global satisfaction from treatment (79.14 ± 10.47 and 83.3 ± 20.82), convenience of treatment (73.78 ± 19.04 and 90.44 ± 11.66), effectiveness of treatment (72.6 ± 10.1 and 79.73 ± 11.6). The only statistically significant difference among gabapentin-experienced and gabapentin-naïve groups was found in adverse event tolerability (65.78 ± 10.36 and 85.8 ± 10.14, p < 0.01). Conclusion Once-daily dosing of gabapentin-extended release showed significant improvement in pain severity and functional status, with no difference found between gabapentin-experienced versus gabapentin-naïve patients.
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Affiliation(s)
- Nebojsa Nick Knezevic
- Department of Anesthesiology, Advocate Illinois Masonic Medical Center, Chicago, IL, United States.,Department of Anesthesiology, The University of Illinois at Chicago, Chicago, IL, United States.,Department of Surgery, The University of Illinois at Chicago, Chicago, IL, United States
| | - Tabish Aijaz
- Department of Anesthesiology, Advocate Illinois Masonic Medical Center, Chicago, IL, United States
| | - Kenneth D Candido
- Department of Anesthesiology, Advocate Illinois Masonic Medical Center, Chicago, IL, United States.,Department of Anesthesiology, The University of Illinois at Chicago, Chicago, IL, United States.,Department of Surgery, The University of Illinois at Chicago, Chicago, IL, United States
| | - Svetlana Kovaleva
- Department of Anesthesiology, Advocate Illinois Masonic Medical Center, Chicago, IL, United States
| | - Alexei Lissounov
- Department of Anesthesiology, Advocate Illinois Masonic Medical Center, Chicago, IL, United States
| | - Ivana Knezevic
- Department of Anesthesiology, Advocate Illinois Masonic Medical Center, Chicago, IL, United States
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A clinical approach to the management of cancer-related pain in emergency situations. Support Care Cancer 2019; 27:3147-3157. [PMID: 31076900 DOI: 10.1007/s00520-019-04830-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 04/23/2019] [Indexed: 02/07/2023]
Abstract
PURPOSE Most cancer patients experience many pain episodes depending on disruptive elements, leading them to the emergency room. The objective of the article is to describe common pitfalls that need to be avoided, as well as opportunities to be seized for repositioning patients back on their care pathway. METHODS Critical reflection based on literature analysis and clinical practice. RESULTS Most forms of cancer are now chronic, evolving diseases, and patients are treated with high-technology targeted therapies with iatrogenic effects. Moreover, the multimorphic nature of cancer-related pain requires dynamic, interdisciplinary assessments addressing its etiology, its pathophysiology, its dimensions (sensory-discriminatory, cognitive, emotional, and behavioral), and the patient's perception of it, in order to propose the most adapted therapies. However, for most patients, cancer pain remains underestimated, poorly assessed, and under-treated. In this context, the key steps in emergency cancer pain management are as follows: • Quick relief of uncontrolled cancer pain: after eliminating potential medical or surgical emergencies revealed by pain, a brief questioning will make the use of carefully titrated morphine in most situations possible. • Assessment and re-assessment of the pain and the patient, screening specific elements, to better understand the situation and its consequences. • Identification of disruptive elements leading to uncontrolled pain, with an interdisciplinary confrontation to find a mid to long-term approach, involving the appropriate pharmaceutical and/or non-pharmaceutical strategies, possibly including interventions. CONCLUSIONS Pain emergencies should be part of the cancer care pathway and, through supportive care, provide an opportunity to help cancer patients both maintain their physical, psychological, and social balance and anticipate further painful episodes.
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Huo BB, Shen J, Hua XY, Zheng MX, Lu YC, Wu JJ, Shan CL, Xu JG. Alteration of metabolic connectivity in a rat model of deafferentation pain: a 18F-FDG PET/CT study. J Neurosurg 2019; 132:1295-1303. [PMID: 30835695 DOI: 10.3171/2018.11.jns181815] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Accepted: 11/21/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Refractory deafferentation pain has been evidenced to be related to central nervous system neuroplasticity. In this study, the authors sought to explore the underlying glucose metabolic changes in the brain after brachial plexus avulsion, particularly metabolic connectivity. METHODS Rats with unilateral deafferentation following brachial plexus avulsion, a pain model of deafferentation pain, were scanned by small-animal 2-deoxy-[18F]fluoro-d-glucose (18F-FDG) PET/CT to explore the changes of metabolic connectivity among different brain regions. Thermal withdrawal latency (TWL) and mechanical withdrawal threshold (MWT) of the intact forepaw were also measured for evaluating pain sensitization. Brain metabolic connectivity and TWL were compared from baseline to 1 week after brachial plexus avulsion. RESULTS Alterations of metabolic connectivity occurred not only within the unilateral hemisphere contralateral to the injured forelimb, but also in the other hemisphere and even in the connections between bilateral hemispheres. Metabolic connectivity significantly decreased between sensorimotor-related areas within the left hemisphere (contralateral to the injured forelimb) (p < 0.05), as well as between areas across bilateral hemispheres (p < 0.05). Connectivity between areas within the right hemisphere (ipsilateral to the injured forelimb) significantly increased (p = 0.034). TWL and MWT of the left (intact) forepaw after surgery were significantly lower than those at baseline (p < 0.001). CONCLUSIONS This study revealed that unilateral brachial plexus avulsion facilitates pain sensitization in the opposite limb. A specific pattern of brain metabolic changes occurred in this procedure. Metabolic connectivity reorganized not only in the sensorimotor area corresponding to the affected forelimb, but also in extensive areas involving the bilateral hemispheres. These findings may broaden our understanding of central nervous system changes, as well as provide new information and a potential intervention target for nosogenesis of deafferentation pain.
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Affiliation(s)
- Bei-Bei Huo
- 1School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine; and
| | - Jun Shen
- 1School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine; and
| | - Xu-Yun Hua
- 1School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine; and.,3Trauma and Orthopedics, Yueyang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Mou-Xiong Zheng
- 1School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine; and.,3Trauma and Orthopedics, Yueyang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Ye-Chen Lu
- 1School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine; and
| | - Jia-Jia Wu
- 1School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine; and.,Departments of2Rehabilitation Medicine and
| | - Chun-Lei Shan
- 1School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine; and.,Departments of2Rehabilitation Medicine and
| | - Jian-Guang Xu
- 1School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine; and.,Departments of2Rehabilitation Medicine and
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Shen J, Huo BB, Hua XY, Zheng MX, Lu YC, Wu JJ, Shan CL, Xu JG. Cerebral 18F-FDG metabolism alteration in a neuropathic pain model following brachial plexus avulsion: A PET/CT study in rats. Brain Res 2019; 1712:132-138. [PMID: 30738025 DOI: 10.1016/j.brainres.2019.02.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 02/03/2019] [Accepted: 02/05/2019] [Indexed: 12/14/2022]
Abstract
The present study aimed to investigate cerebral metabolic changes in a neuropathic pain model following deafferentation. A total of 24 Sprague-Dawley rats were included for modeling of right brachial plexus avulsion (BPA) through the posterior approach. As nerve injury would cause central sensitization and facilitate pain sensitivity in other parts of the body, thermal withdrawal latency (TWL) of the intact forepaw was assessed to investigate the level of pain perception following BPA-induced neuropathic pain. [Fluorine-18]-fluoro-2-deoxy-d-glucose (18F-FDG) positron emission tomography (PET) was applied to the brain before and after brachial plexus avulsion to explore metabolic changes in neuropathic pain following deafferentation. The TWL of the left (intact) forepaw was significantly lower after BPA than that of baseline (p < 0.001). Using TWL as a covariate, standardized uptake values (SUVs) of 18F-FDG significantly increased in the ipsilateral dorsolateral thalamus and contralateral anterodorsal hippocampus after BPA. Conversely, SUVs in multiple brain regions decreased, including the contralateral somatosensory cortex, ipsilateral cingulate cortex, and ipsilateral temporal association cortex. The Pearson correlation analysis showed that the SUVs of the contralateral anterodorsal hippocampus and ipsilateral dorsolateral thalamus were negatively related to the TWL of the intact forepaw, whereas the SUVs in the contralateral somatosensory cortex and ipsilateral cingulate cortex were positively related to it (p < 0.05). These findings indicate that upregulation of metabolism in the anterodorsal hippocampus and dorsolateral thalamus and downregulation metabolism in the contralateral somatosensory cortex and ipsilateral cingulate cortex could be a unique pattern of metabolic changes for neuropathic pain following brachial plexus avulsion.
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Affiliation(s)
- Jun Shen
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Bei-Bei Huo
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xu-Yun Hua
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China; Department of Trauma and Orthopedics, Yueyang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Mou-Xiong Zheng
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China; Department of Trauma and Orthopedics, Yueyang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Ye-Chen Lu
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Jia-Jia Wu
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Chun-Lei Shan
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China; Department of Rehabilitation Medicine, Yueyang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Jian-Guang Xu
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China; Department of Rehabilitation Medicine, Yueyang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China.
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Lund I, Lundeberg T. Aspects of Pain, Its Assessment and Evaluation from An Acupuncture Perspective. Acupunct Med 2018; 24:109-17. [PMID: 17013357 DOI: 10.1136/aim.24.3.109] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Pain is a major clinical problem that causes great suffering for the individual and incurs costs for society. Accurate assessment and evaluation of perceived pain is necessary for diagnosis, for choice of treatment, and for the evaluation of treatment efficacy. The assessment of an individual's pain is a challenge since pain is a subjective, multidimensional experience, and assessment is based on the person's own self-report. The results are often varied, possibly due to inter-individual variation, but also in relation to gender and aetiology. A gold standard for pain assessment is still lacking, but rating scales, questionnaires, and methods derived from psychophysical concepts, such as threshold assessments and perceptual matching, are used. In the evaluation of pain and associated variables, both systematic and individual variation should be taken into account, as should pain-associated symptoms. Recommendations for pain treatment should be based on the patient's specific needs. Therefore, it is important to assess the level of perceived pain taking individual variation into account. The methods used should preferably have proved to be useful in randomised controlled trials, and analysis of pain assessment should consider its non-metric properties. In the future, the use of studies with a naturalistic protocol together with individual assessment of individual pain responses could increase the internal and external validity.
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Affiliation(s)
- Irene Lund
- Karolinska Institutet, stockholm, Sweden.
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Palanivelu V, Maghami S, Wallace HJ, Wijeratne D, Wood FM, Fear MW. Loss of Type A neuronal cells in the dorsal root ganglion after a non-severe full-thickness burn injury in a rodent model. Burns 2018; 44:1792-1800. [DOI: 10.1016/j.burns.2018.04.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 03/27/2018] [Accepted: 04/05/2018] [Indexed: 01/06/2023]
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The Current State of Deep Brain Stimulation for Chronic Pain and Its Context in Other Forms of Neuromodulation. Brain Sci 2018; 8:brainsci8080158. [PMID: 30127290 PMCID: PMC6119957 DOI: 10.3390/brainsci8080158] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 08/08/2018] [Accepted: 08/13/2018] [Indexed: 12/26/2022] Open
Abstract
Chronic intractable pain is debilitating for those touched, affecting 5% of the population. Deep brain stimulation (DBS) has fallen out of favour as the centrally implantable neurostimulation of choice for chronic pain since the 1970–1980s, with some neurosurgeons favouring motor cortex stimulation as the ‘last chance saloon’. This article reviews the available data and professional opinion of the current state of DBS as a treatment for chronic pain, placing it in the context of other neuromodulation therapies. We suggest DBS, with its newer target, namely anterior cingulate cortex (ACC), should not be blacklisted on the basis of a lack of good quality study data, which often fails to capture the merits of the treatment.
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Psychological Factors Associated with Phantom Limb Pain: A Review of Recent Findings. Pain Res Manag 2018; 2018:5080123. [PMID: 30057653 PMCID: PMC6051014 DOI: 10.1155/2018/5080123] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 05/12/2018] [Indexed: 01/21/2023]
Abstract
Phantom limb pain (PLP) is a common phenomenon occurring after the amputation of a limb and can be accompanied by serious suffering. Psychological factors have been shown to play an important role in other types of chronic pain, where they are pivotal in the acquisition and maintenance of pain symptoms. For PLP, however, the interaction between pain and psychological variables is less well documented. In this review, we summarize research on the role of emotional, motivational, cognitive, and perceptual factors in PLP. The reported findings indicate that emotional factors modulate PLP but might be less important compared to other types of chronic pain. Additional factors such as the amount of disability and adjustment to the amputation appear to also play a role. Bidirectional relationships between stress and PLP have been shown quite consistently, and the potential of stress and tension reduction in PLP treatment could be further exploited. Little is known about the role of cognitive variables such as attention or expectation. Catastrophizing seems to aggravate PLP and could be targeted in treatment. Body perception is altered in PLP and poses a potential target for novel mechanistic treatments. More research on psychological factors and their interactions in PLP is needed.
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Han MM, Yang CW, Cheung CW, Li J. Blockage of spinal endothelin A receptors attenuates bone cancer pain via regulation of the Akt/ERK signaling pathway in mice. Neuropeptides 2018; 68:36-42. [PMID: 29395120 DOI: 10.1016/j.npep.2018.01.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Revised: 12/17/2017] [Accepted: 01/21/2018] [Indexed: 10/18/2022]
Abstract
Bone cancer pain (BCP) is a common source of pain in patients with advanced stage and metastatic cancer; however, existing treatment for this kind of pain remains deficient. Being closely related to sensory change and inflammatory pain in both the central and peripheral nervous systems, endothelin A receptor (ETAR) plays an essential role in pain processing. As a result, ETAR antagonist has been reported to alleviate both neuropathic and inflammatory pain. Thus far, the role of ETAR in the process of BCP is still ambiguous. In this study, by using a BCP mouse model, the analgesic effect and molecular mechanism of the ETAR antagonist BQ-123 was investigated. Pain sensation in the BCP mouse model was investigated by the number of spontaneous flinches (NSF) and pain withdrawal threshold (PWT), and the mechanism of BCP was assessed by measuring p-Akt, p-Akt/t-Akt, p-ERK-1/2 and p-ERK-1/2/t-ERK-1/2 levels in L4-6 segments of the spinal cord. Our results demonstrated that BCP mice showed a higher NSF and a lower PWT score than Sham mice. In addition to the development of nociceptive sensitization, p-Akt, p-Akt/t-Akt, p-ERK-1/2 and p-ERK-1/2/t-ERK-1/2 were up-regulated correspondingly in L4-6 segments of the spinal cord in BCP mice. BQ-123 treatment showed a promising analgesic effect, and the effect was correlated to the down-regulation of p-Akt, p-Akt/t-Akt, p-ERK-1/2 and p-ERK-1/2/t-ERK-1/2 in spinal cord cells. The results suggested that intrathecal administration of BQ-123 was able to relieve BCP in mice as a consequence of suppressing the Akt and ERK signalling pathways.
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Affiliation(s)
- Ming-Ming Han
- School of Medicine, Shandong University, Jinan, Shandong, China; Department of Anesthesiology, Anhui Provincial Hospital, Anhui Medical University, Hefei, China
| | - Cheng-Wei Yang
- School of Medicine, Shandong University, Jinan, Shandong, China; Department of Anesthesiology, Anhui Provincial Hospital, Anhui Medical University, Hefei, China
| | - Chi-Wai Cheung
- Department of Anesthesiology, The University of Hong Kong, Hong Kong, China; Laboratory and Clinical Research Institute for Pain, The University of Hong Kong, Hong Kong, China; Research Center of Heart, Brain, Hormone and Healthy Aging, The University of Hong Kong, Hong Kong, China
| | - Juan Li
- Department of Anesthesiology, Anhui Provincial Hospital, Anhui Medical University, Hefei, China; School of Medicine, Shandong University, Jinan, Shandong, China.
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Ruan JP, Mao QH, Lu WG, Cai XT, Chen J, Li Q, Fu Q, Yan HJ, Cao JL, Cao P. Inhibition of spinal MAPKs by scorpion venom peptide BmK AGAP produces a sensory-specific analgesic effect. Mol Pain 2018; 14:1744806918761238. [PMID: 29424271 PMCID: PMC5844526 DOI: 10.1177/1744806918761238] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background Several studies have shown that scorpion venom peptide BmK AGAP has an analgesic activity. Our previous study also demonstrated that intraplantar injection of BmK AGAP ameliorates formalin-induced spontaneous nociceptive behavior. However, the effect of intrathecal injection of BmK AGAP on nociceptive processing is poorly understood. Methods We investigated the effects of intrathecal injection of BmK AGAP on spinal nociceptive processing induced by chronic constrictive injury or formalin. Thermal hyperalgesia and mechanical allodynia were measured using radiant heat and the von Frey filaments test. Formalin-induced spontaneous nociceptive behavior was also investigated. C-Fos expression was assessed by immunohistochemistry. Phosphorylated mitogen-activated protein kinase (p-MAPK) expression was monitored by Western blot assay. Results Intrathecal injection of BmK AGAP reduced chronic constrictive injury-induced neuropathic pain behavior and pain from formalin-induced inflammation, accompanied by decreased expression of spinal p-MAPKs and c-Fos protein. The results of combining low doses of different MAPK inhibitor (U0126, SP600125, or SB203580; 0.1 µg for each inhibitor) with a low dose of BmK AGAP (0.2 µg) suggested that BmK AGAP could potentiate the effects of MAPK inhibitors on inflammation-associated pain. Conclusion Our results demonstrate that intrathecal injection of BmK AGAP produces a sensory-specific analgesic effect via a p-MAPK-dependent mechanism.
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Affiliation(s)
- Jia-Ping Ruan
- 1 Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, 66478 Nanjing University of Chinese Medicine , Nanjing, Jiangsu, China.,2 375808 Jiangsu Province Academy of Traditional Chinese Medicine , Nanjing, Jiangsu, China
| | - Qing-Hong Mao
- 1 Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, 66478 Nanjing University of Chinese Medicine , Nanjing, Jiangsu, China.,2 375808 Jiangsu Province Academy of Traditional Chinese Medicine , Nanjing, Jiangsu, China
| | - Wu-Guang Lu
- 1 Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, 66478 Nanjing University of Chinese Medicine , Nanjing, Jiangsu, China.,2 375808 Jiangsu Province Academy of Traditional Chinese Medicine , Nanjing, Jiangsu, China
| | - Xue-Ting Cai
- 1 Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, 66478 Nanjing University of Chinese Medicine , Nanjing, Jiangsu, China.,2 375808 Jiangsu Province Academy of Traditional Chinese Medicine , Nanjing, Jiangsu, China
| | - Jiao Chen
- 1 Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, 66478 Nanjing University of Chinese Medicine , Nanjing, Jiangsu, China.,2 375808 Jiangsu Province Academy of Traditional Chinese Medicine , Nanjing, Jiangsu, China
| | - Qing- Li
- 1 Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, 66478 Nanjing University of Chinese Medicine , Nanjing, Jiangsu, China.,2 375808 Jiangsu Province Academy of Traditional Chinese Medicine , Nanjing, Jiangsu, China
| | - Qun- Fu
- 1 Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, 66478 Nanjing University of Chinese Medicine , Nanjing, Jiangsu, China.,2 375808 Jiangsu Province Academy of Traditional Chinese Medicine , Nanjing, Jiangsu, China
| | - Huai-Jiang Yan
- 1 Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, 66478 Nanjing University of Chinese Medicine , Nanjing, Jiangsu, China.,2 375808 Jiangsu Province Academy of Traditional Chinese Medicine , Nanjing, Jiangsu, China
| | - Jun-Li Cao
- 3 Jiangsu Key Laboratory of Anesthesiology, Affiliated Hospital of Xuzhou Medical College, Xuzhou, Jiangsu, China
| | - Peng Cao
- 1 Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, 66478 Nanjing University of Chinese Medicine , Nanjing, Jiangsu, China.,2 375808 Jiangsu Province Academy of Traditional Chinese Medicine , Nanjing, Jiangsu, China
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Comparison of Intra-articular Thoracic Facet Joint Steroid Injection and Thoracic Medial Branch Block for the Management of Thoracic Facet Joint Pain. Spine (Phila Pa 1976) 2018; 43:76-80. [PMID: 28591071 DOI: 10.1097/brs.0000000000002269] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A prospective observational study. OBJECTIVE The aim of this study was to show the effect of intra-articular (IA) thoracic facet joint (TFJ) steroid injection for the management of TFJ pain, and to compare it with the effect of therapeutic thoracic medial branch block (MBB) with a local anesthetic and steroid. SUMMARY OF BACKGROUND DATA Several studies have shown the effects of thoracic MBB with local anesthetics with or without steroids and radiofrequency neurotomy in managing TFJ pain, but thus far, the effectiveness of IA TFJ steroid injection has not been studied. METHODS Forty patients with TFJ pain were recruited and randomly assigned to one of two groups, the IA steroid injection and the MBB group, each with 20 patients. For IA TFJ steroid injection and therapeutic MBB, we injected 0.5 mL of 0.5% bupivacaine, mixed with 10 mg (0.25 mL) of dexamethasone. We assessed the severity of TFJ pain using a numeric rating scale (NRS) before treatment and at 1, 3, and 6 months after treatment. RESULTS Compared to the pretreatment NRS scores, the NRS scores at 1, 3, and 6 months after each treatment showed a significant decrease in patients in both the groups. Intergroup changes in the NRS scores were not significantly different over time. Six months after the treatment, 65% of the patients in the IA steroid injection group reported successful pain relief (pain relief ≥50%), and 40% of the patients in the MBB group showed successful pain relief. CONCLUSION In the present study, both IA TFJ steroid injection and therapeutic MBB significantly relieved TFJ pain. Their effects persisted for at least 6 months after the procedure. Thus, we think that both IA TFJ steroid injection and therapeutic thoracic MBB are useful treatment options for managing TFJ pain. LEVEL OF EVIDENCE 2.
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Chang MC. Effect of Pulsed Radiofrequency Treatment on the Thoracic Medial Branch for Managing Chronic Thoracic Facet Joint Pain Refractory to Medial Branch Block with Local Anesthetics. World Neurosurg 2017; 111:e644-e648. [PMID: 29294395 DOI: 10.1016/j.wneu.2017.12.141] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 12/20/2017] [Accepted: 12/21/2017] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To evaluate the effect of pulsed radiofrequency (PRF) stimulation of the thoracic medial branch of the dorsal ramus in patients with chronic thoracic facet joint (TFJ) pain who were refractory to medial branch block (MBB). METHODS This was a prospective, observational study. The author retrospectively reviewed data from 72 patients who had received therapeutic MBB with 0.5 mL of 2% lidocaine mixed with 0.5 mL of 0.25% bupivacaine to treat TFJ-origin upper or midback pain. Of these patients, 20 were included to evaluate the effects of PRF on the thoracic medical branch to manage TFJ pain refractory to therapeutic MBB. PRF stimulation was administered at 5 Hz and a 5-millisecond pulsed width for 360 seconds at 45 V. The pain-reducing effect of the PRF procedure was evaluated via the numeric rating scale (NRS) at 1, 2, and 3 months after treatment. Successful pain relief was defined as ≥50% reduction in the NRS score compared with the score before treatment. RESULTS The NRS scores changed significantly over time (pretreatment, 6.0 ± 1.0; 1 month, 3.3 ± 2.2; 2 months, 3.9 ± 2.1; and 3 months, 4.0 ± 2.2). At 1, 2, and 3 months after the PRF procedure, the NRS scores were significantly reduced compared with the scores before the treatment. Eleven (55%) of 20 patients reported successful pain relief at 3 months after PRF. CONCLUSIONS The author suggests that PRF on the thoracic medial branch is an effective and safe interventional technique for the control of chronic TFJ pain.
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Affiliation(s)
- Min Cheol Chang
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Taegu, Republic of Korea.
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Enomoto M, Lascelles BDX, Gerard MP. Defining local nerve blocks for feline distal pelvic limb surgery: a cadaveric study. J Feline Med Surg 2017; 19:1215-1223. [PMID: 28186424 PMCID: PMC11104168 DOI: 10.1177/1098612x17690652] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/27/2024]
Abstract
Objectives Anatomical and methodological detail is lacking regarding local anesthetic peripheral nerve block techniques for distal pelvic limb surgery in cats. The aim of this study was to develop, describe and test nerve block methods based on cadaveric dissections and dye injections. Methods Ten pairs of feline pelvic limbs (n = 20) were dissected and the tibial nerve (T n.), common fibular (peroneal) nerve (CF n., and its two branches, the superficial fibular [peroneal] nerve [SpF n.] and the deep fibular [peroneal] nerve [DpF n.]) and the saphenous nerve (Sa n.) were identified. Based on these dissections, a 'distal crus block' (selective blockade of the CF n., T n. and Sa n.) and a 'distal pes block' (selective blockade of the SpF n., DpF n., T n. and Sa n.) were developed for surgical procedures in two different regions of the distal pelvic limb. Techniques were tested using new methylene blue (NMB) dye injections in feline pelvic limbs (n = 12). Using a 25 G × 5/8 inch needle and 1 ml syringe, 0.1 ml/kg of NMB dye solution was injected at the site of the CF n., and 0.05 ml/kg was injected at the sites of the SpF n., DpF n., Sa n. and T n. The length and circumference (fully or partially stained) of each stained nerve were measured. Results Positive staining of nerves was observed in 12/12 limbs. The lengths stained for the CF n., DpF n., SpF n., Sa n. and T n. were 27.19 ± 7.13, 20.39 ± 5.57, 22.82 ± 7.13, 30.89 ± 6.99 and 25.16 ± 8.09 mm, respectively. The nerves were fully stained in 12, 12, 10, 11 and 11 out of 12 limbs, respectively. Conclusions and relevance These two, three-point injection methods may be an effective perioperative analgesia technique for feline distal pelvic limb procedures.
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Affiliation(s)
- Masataka Enomoto
- Comparative Pain Research Laboratory, Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, USA
| | - B Duncan X Lascelles
- Comparative Pain Research Laboratory, Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, USA
- Comparative Medicine Institute, North Carolina State University, Raleigh, NC, USA
- Center for Pain Research and Innovation, University of North Carolina, School of Dentistry, Chapel Hill, NC, USA
- Center for Translational Pain Research, Department of Anesthesiology, Duke University, Durham, NC, USA
| | - Mathew P Gerard
- Department of Molecular Biomedical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, USA
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Abstract
Study design Narrative review. Method Eight bibliographic databases were searched for studies published in the (last five years up until Feb 2017). For the two database searches (Cochrane and DARE), the time frame was unlimited. The review involved keyword searches of the term 'Amputation' AND 'chronic pain'. Studies selected were interrogated for any association between peri-operative factors and the occurrence of chronic post amputation pain (CPAP). Results Heterogeneity of study populations and outcome measures prevented a systematic review and hence a narrative synthesis of results was undertaken. The presence of variation in two gene alleles (GCH1 and KCNS1) may be relevant for development of CPAP. There was little evidence to draw conclusions on the association between age, gender and CPAP. Pre-operative anxiety and depression influenced pain intensity post operatively and long-term post amputation pain (CPAP). The presence of pre-amputation pain is correlated to the development of acute and chronic post amputation pain while evidence for the association of post-operative pain with CPAP is modest. Regional anaesthesia and peri-neural catheters improve acute postoperative pain relief but evidence on their efficacy to prevent CPAP is limited. A suggested whole system pathway based on current evidence to optimize peri-operative amputation pain is described. Conclusion The current evidence suggests that optimized peri-operative analgesia reduces the incidence of acute peri-operative pain but no firm conclusion can be drawn on reducing risk for CPAP.
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Affiliation(s)
- Devjit Srivastava
- Department of Anaesthesia, Raigmore Hospital, Inverness, Scotland, United Kingdom, IV2 3UJ
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Abstract
Study Design Controlled laboratory study. Background Spinal manipulation (SM) can trigger a cascade of responses involving multiple systems, including the sympathetic nervous system and the endocrine system, specifically, the hypothalamic-pituitary axis. However, no manual therapy study has investigated the neuroendocrine response to SM (ie, sympathetic nervous system-hypothalamic-pituitary axis) in the same trial. Objective To determine short-term changes in sympathetic nervous system activity, heart rate variability, and endocrine activity (cortisol, testosterone, and testosterone-cortisol [T/C] ratio) following a thoracic SM. Methods Twenty-four healthy men aged between 18 and 45 years were randomized into 2 groups: thoracic SM (n = 12) and sham (n = 12). Outcome measures were salivary cortisol (micrograms per deciliter), salivary testosterone (picograms per milliliter), T/C ratio, heart rate variability, and changes in oxyhemoglobin concentration of the right calf muscle (micromoles per liter). Measurements were done before and at 5 minutes, 30 minutes, and approximately 6 hours after intervention. Results A statistically significant group-by-time interaction was noted for T/C ratio (P<.05) and salivary cortisol (P<.01) concentrations. Significant between-group differences were noted for salivary cortisol concentration at 5 minutes (mean difference, 0.35; 95% confidence interval: 0.12, 0.6; interaction: P<.01) and for T/C ratio at 6 hours postintervention (mean difference, -0.09; 95% confidence interval: -0.16, -0.04; P = .02). However, SM did not differentially alter oxyhemoglobin, testosterone, or heart rate variability relative to responses in the sham group. Conclusion Thoracic SM resulted in an immediate decrease in salivary cortisol concentration and reduced T/C ratio 6 hours after intervention. A pattern of immediate sympathetic excitation was also observed in the SM group. J Orthop Sports Phys Ther 2017;47(9):617-627. Epub 13 Jul 2017. doi:10.2519/jospt.2017.7348.
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Mücke M, Schulze H, Radbruch L, Marinova M, Cuhls H, Kravchenko D, Conrad R, Rolke R. [Neuromodulation using matrix stimulation : A treatment for acute pain?]. Schmerz 2017; 31:594-600. [PMID: 28674829 DOI: 10.1007/s00482-017-0233-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND There is currently a lack of studies that evaluate the effects of matrix electrode neuromodulation on acute pain. In this prospective and randomized cross-over study, we investigated the efficacy of 4 Hz-matrix stimulation on venipuncture-induced pain in 30 healthy subjects. METHODS We compared two conditions of neurostimulation: in EC1 (experimental condition 1), we performed venipuncture during stimulation, with 2.5 min of prestimulation with 600 stimuli; in EC2 (experimental condition 2), the length of stimulation was 5 min, at 1200 stimuli, with subsequent venipuncture. A group with no stimulation was used as control condition. RESULTS The EC2 group did not only show a 77% reduction in puncture pain when compared to the control group (p < 0.001; effect size [ES] d = 1.45), but also had a significant effect compared with EC1 (p < 0.001; ES d = 1.33). EC1, on the other hand, did not demonstrate a significant difference to the control group. The status of the veins was evaluated based on visibility and did not differ significantly between the conditions. CONCLUSION The results of this study showed for the first time that pre-emptive matrix stimulation could be an effective way to reduce acute pain. The duration of stimulation seems to play a key role in the effectiveness of the neurophysiological mechanism of action. Matrix stimulation is a therapeutic intervention with very few side effects, which could, in the future, expand our pain-management options for the treatment of acute pain.
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Affiliation(s)
- M Mücke
- Klinik für Palliativmedizin, Universitätsklinikum Bonn, Bonn, Deutschland.
- Institut für Hausarztmedizin, Universitätsklinikum Bonn, Bonn, Deutschland.
- Zentrum für Seltene Erkrankungen (ZSEB), Universitätsklinikum Bonn, Bonn, Deutschland.
| | - H Schulze
- Klinik für Palliativmedizin, Universitätsklinikum Bonn, Bonn, Deutschland
| | - L Radbruch
- Klinik für Palliativmedizin, Universitätsklinikum Bonn, Bonn, Deutschland
- Zentrum für Palliativmedizin, Malteser Krankenhaus Seliger Gerhard Bonn/Rhein-Sieg, Bonn, Deutschland
| | - M Marinova
- Radiologische Klinik, Universitätsklinikum Bonn, Bonn, Deutschland
| | - H Cuhls
- Klinik für Palliativmedizin, Universitätsklinikum Bonn, Bonn, Deutschland
| | - D Kravchenko
- Klinik für Palliativmedizin, Universitätsklinikum Bonn, Bonn, Deutschland
- Klinik und Poliklinik für Psychosomatische Medizin und Psychotherapie, Universitätsklinikum Bonn, Bonn, Deutschland
| | - R Conrad
- Klinik und Poliklinik für Psychosomatische Medizin und Psychotherapie, Universitätsklinikum Bonn, Bonn, Deutschland
| | - R Rolke
- Klinik für Palliativmedizin, Uniklinik RWTH Aachen, Aachen, Deutschland
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Kim SK, Nabekura J, Koizumi S. Astrocyte-mediated synapse remodeling in the pathological brain. Glia 2017; 65:1719-1727. [PMID: 28569048 DOI: 10.1002/glia.23169] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 05/03/2017] [Accepted: 05/05/2017] [Indexed: 01/02/2023]
Abstract
Astrocytes, a major type of glia, reciprocally influence synaptic transmission and connectivity, forming the "tripartite synapses". Astrocytic metabotropic glutamate receptor (mGluR)-mediated Ca2+ waves and release of gliotransmitters or synaptogenic molecules mediate this neuron-glia interaction in the developing brain, but this signaling has been challenged for adult brain. However, cumulative evidence has suggested that mature astrocytes exhibit re-awakening of such immature phenotype in the pathological adult brain. This phenotypic change in astrocytes in response to injury may induce neural circuit and synapse plasticity. In this review article, we summarize astrocyte-mediated synapse remodeling during physiological development, discuss re-emergence of immature astrocytic signaling in adult pathological brain, and finally highlight its contribution to significant modification of synaptic connections correlating with functional progress of brain pathology.
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Affiliation(s)
- Sun Kwang Kim
- Department of Physiology, College of Korean Medicine, Kyung Hee University, Seoul, 02447, Korea
| | - Junichi Nabekura
- Division of Homeostatic Development, National Institute for Physiological Sciences, Okazaki, Aichi, 444-8585, Japan.,Department of Physiological Sciences, The Graduate School for Advanced Study, Hayama, Kanagawa, 240-0193, Japan.,Core Research for Evolutional Science and Technology, Japan Science and Technology Agency, Tokyo, 102-0076, Japan
| | - Schuichi Koizumi
- Core Research for Evolutional Science and Technology, Japan Science and Technology Agency, Tokyo, 102-0076, Japan.,Department of Neuropharmacology, Interdisciplinary Graduate School of Medicine, University of Yamanashi, Yamanashi, 409-3898, Japan
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Boadas-Vaello P, Homs J, Reina F, Carrera A, Verdú E. Neuroplasticity of Supraspinal Structures Associated with Pathological Pain. Anat Rec (Hoboken) 2017; 300:1481-1501. [PMID: 28263454 DOI: 10.1002/ar.23587] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Revised: 09/27/2016] [Accepted: 10/18/2016] [Indexed: 12/19/2022]
Abstract
Peripheral nerve and spinal cord injuries, along with other painful syndromes such as fibromyalgia, diabetic neuropathy, chemotherapeutic neuropathy, trigeminal neuralgia, complex regional pain syndrome, and/or irritable bowel syndrome, cause several neuroplasticity changes in the nervous system along its entire axis affecting the different neuronal nuclei. This paper reviews these changes, focusing on the supraspinal structures that are involved in the modulation and processing of pain, including the periaqueductal gray matter, red nucleus, locus coeruleus, rostral ventromedial medulla, thalamus, hypothalamus, basal ganglia, cerebellum, habenula, primary, and secondary somatosensory cortex, motor cortex, mammillary bodies, hippocampus, septum, amygdala, cingulated, and prefrontal cortex. Hyperexcitability caused by the modification of postsynaptic receptor expression, central sensitization, and potentiation of presynaptic delivery of neurotransmitters, as well as the reduction of inhibitory inputs, changes in dendritic spine, neural circuit remodeling, alteration of gray matter, and upregulation of proinflammatory mediators (e.g., cytokines) by reactivation of astrocytes and microglial cells are the main functional, structural, and molecular neuroplasticity changes observed in the above supraspinal structures, associated with pathological pain. Studying these changes in greater depth may lead to the implementation and improvement of new therapeutic strategies against pathological pain. Anat Rec, 300:1481-1501, 2017. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Pere Boadas-Vaello
- Research Group of Clinical Anatomy, Embryology and Neuroscience (NEOMA), Department of Medical Sciences, Faculty of Medicine, Universitat de Girona, Girona, Catalonia, 17003, Spain
| | - Judit Homs
- Research Group of Clinical Anatomy, Embryology and Neuroscience (NEOMA), Department of Medical Sciences, Faculty of Medicine, Universitat de Girona, Girona, Catalonia, 17003, Spain.,Department of Physical Therapy EUSES-Universitat of Girona, Salt (Girona), Catalonia, 17190, Spain
| | - Francisco Reina
- Research Group of Clinical Anatomy, Embryology and Neuroscience (NEOMA), Department of Medical Sciences, Faculty of Medicine, Universitat de Girona, Girona, Catalonia, 17003, Spain
| | - Ana Carrera
- Research Group of Clinical Anatomy, Embryology and Neuroscience (NEOMA), Department of Medical Sciences, Faculty of Medicine, Universitat de Girona, Girona, Catalonia, 17003, Spain
| | - Enrique Verdú
- Research Group of Clinical Anatomy, Embryology and Neuroscience (NEOMA), Department of Medical Sciences, Faculty of Medicine, Universitat de Girona, Girona, Catalonia, 17003, Spain
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Scandola M, Aglioti SM, Avesani R, Bertagnoni G, Marangoni A, Moro V. Corporeal illusions in chronic spinal cord injuries. Conscious Cogn 2017; 49:278-290. [DOI: 10.1016/j.concog.2017.01.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 11/01/2016] [Accepted: 01/13/2017] [Indexed: 12/13/2022]
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Brennstuhl MJ, Tarquinio C, Montel S, Masson J, Bassan F, Tarquinio P. Utilisation de la thérapie Eye Movement Desensitization and Reprocessing (EMDR) pour le traitement du syndrome du sein fantôme : étude pilote. PSYCHOLOGIE FRANCAISE 2017. [DOI: 10.1016/j.psfr.2015.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Sertel M, Bakar Y, Şimşek TT. THE EFFECT OF BODY AWARENESS THERAPY AND AEROBIC EXERCISES ON PAIN AND QUALITY OF LIFE IN THE PATIENTS WITH TENSION TYPE HEADACHE. AFRICAN JOURNAL OF TRADITIONAL, COMPLEMENTARY, AND ALTERNATIVE MEDICINES : AJTCAM 2017; 14:288-310. [PMID: 28573246 PMCID: PMC5446455 DOI: 10.21010/ajtcam.v14i2.31] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND This study is to investigate the effect of Body Awareness Therapy (BAT) and Aerobic Exercises on pain and quality of life in patients with Tension-Type Headache (TTH). MATERIALS AND METHOD Sixty individuals with TTH diagnosis who referred Neurologist were incorporated into study. The individuals were randomly grouped into 3 as BAT (n=20), aerobic exercise (n=20) and control group (n=20). Pain severity of the individuals was evaluated by Visual Analog Scale (VAS) and pain diary, disability with ache; by Pain Disability Index (PDI) and Headache Impact Tests (HIT) and quality of life was evaluated by SF-36. Subsequent to first assessments, 3 sessions of 60 minutes per week throughout 6 weeks totally. RESULTS When the groups were compared at the end of the study, a significant decrease was observed in VAS, PDI and HIT values in the individuals in the BAT and aerobic exercise groups. With the individuals in group BAT and aerobic exercise all parameters of quality of life were observed to be increased significantly. CONCLUSION BAT and aerobic exercise programs to be applied on TTH patients were concluded to be important in decreasing the pain, in increasing the quality of life and in reducing pain-related daily constraints of the individuals.
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Affiliation(s)
- Meral Sertel
- Kırıkkale University, Faculty of Health Sciences, Departmant of Physical Therapy and Rehabilitation, Kırıkkale, 71451, Turkey
| | - Yeşim Bakar
- Abant İzzet Baysal University, School of Physical Therapy and Rehabilitation, Bolu, 14100, Turkey
| | - Tülay Tarsuslu Şimşek
- Dokuz Eylül University, School of Physical Therapy and Rehabilitation, İzmir, 35100, Turkey
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