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Thanaboriboon C, Matos Macêdo MC, Perez J. Complex Regional Pain Syndrome in Cancer Cases: Current Knowledge and Perspectives. Int Med Case Rep J 2024; 17:497-506. [PMID: 38778887 PMCID: PMC11110819 DOI: 10.2147/imcrj.s451291] [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: 12/15/2023] [Accepted: 05/02/2024] [Indexed: 05/25/2024] Open
Abstract
Background Complex regional pain syndrome (CRPS) is a disabling painful disorder caused by many different and poorly understood mechanisms. It often affects the distal limbs and usually happens as consequence of a trauma. Its severity can remarkably affect patients' quality of life. When this painful complication happens in a cancer patient, the impact may be exponential. To date, there is limited knowledge of the surrounding circumstances of CRPS cases in this population. Methods We present two clinical cases of patients diagnosed with cancer-related pain presenting with symptoms and signs compatible with CRPS. In one case, CRPS was attributed to direct tumor nerve compression, and it responded successfully to an interventional pain procedure. The second case was associated with a Zoster infection in an immunocompromised cancer patient. Patient responded to multidisciplinary pain management strategies. Additionally, we conducted a literature review to investigate the coexistence of cancer pain and CRPS and suggest some pathophysiology mechanisms of action. Results and Discussion Literature reviewed and potential pathophysiology mechanisms are simultaneously explored in terms of classification, etiopathology, evidence, challenges, and future scientific directions. Conclusion Comorbid CRPS can impact negatively in cases of cancer pain by affecting their diagnosis and treatment. Further studies are necessary to elucidate how these two conditions present together and how they can be better addressed.
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Affiliation(s)
- Chanon Thanaboriboon
- Cancer Pain Clinic, Departments of Anesthesiology and Supportive and Palliative Care, McGill University Health Center, Montreal, Quebec, Canada
- Department of Anesthesiology, King Chulalongkorn Memorial Hospital and Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Márcia C Matos Macêdo
- Cancer Pain Clinic, Departments of Anesthesiology and Supportive and Palliative Care, McGill University Health Center, Montreal, Quebec, Canada
- Department of Medicine, Federal University of Sergipe, Aracaju, Sergipe, Brazil
| | - Jordi Perez
- Cancer Pain Clinic, Departments of Anesthesiology and Supportive and Palliative Care, McGill University Health Center, Montreal, Quebec, Canada
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Buffon AC, Salm DC, Heymanns AC, Donatello NN, Martins DC, Wichmann JF, Giacomello L, Horewicz VV, Martins DF, Piovezan AP. Complex Regional Pain Syndrome Type I: Evidence for the CB1 and CB2 Receptors Immunocontent and Beneficial Effect of Local Administration of Cannabidiol in Mice. Cannabis Cannabinoid Res 2023. [PMID: 37903029 DOI: 10.1089/can.2023.0093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2023] Open
Abstract
Introduction: Complex regional pain syndrome type I (CRPS-I) is a debilitating neuropathic painful condition associated with allodynia, hyperalgesia, sudomotor and/or vasomotor dysfunctions, turning investigation of its pathophysiology and new therapeutic strategies into an essential topic. We aim to investigate the impact of ischemia/reperfusion injury on the immunocontent of CB1 and CB2 cannabinoid receptor isoforms in the paws of mice submitted to a chronic postischemia pain (CPIP) model and the effects of local administration of cannabidiol (CBD) on mechanical hyperalgesia. Methods: Female Swiss mice, 30-35 g, were submitted to the CPIP model on the right hind paw. Skin and muscle samples were removed at different periods for western blot analysis. Results: No changes in the immunocontent of CB1 and CB2 receptors in paw muscle tissues after ischemia-reperfusion were observed. CBD promoted an antihyperalgesic effect in both phases. AM281 reversed the effect of CBD, whereas ruthenium red abolished the late phase. Conclusion: Our results point to the possible beneficial effects of local administration of CBD in modulating CRPS-I in humans. As possible targets for CBD antihyperalgesia in this model, the contribution of cannabinoid receptor CB1, in addition to TRPM8 is suggested.
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Affiliation(s)
- Alexandre C Buffon
- Laboratory of Experimental Neuroscience (LANEX), University of Southern Catarina (UNISUL), Palhoça, Santa Catarina, Brazil
- Post-Graduate Program in Health Sciences, University of Southern Catarina (UNISUL), Palhoça, Santa Catarina, Brazil
- Medicine Degree Course, University of Southern Catarina (UNISUL), Palhoça, Santa Catarina, Brazil
| | - Daiana C Salm
- Laboratory of Experimental Neuroscience (LANEX), University of Southern Catarina (UNISUL), Palhoça, Santa Catarina, Brazil
- Post-Graduate Program in Health Sciences, University of Southern Catarina (UNISUL), Palhoça, Santa Catarina, Brazil
| | - Ana C Heymanns
- Laboratory of Experimental Neuroscience (LANEX), University of Southern Catarina (UNISUL), Palhoça, Santa Catarina, Brazil
- Post-Graduate Program in Health Sciences, University of Southern Catarina (UNISUL), Palhoça, Santa Catarina, Brazil
| | - Nathalia N Donatello
- Laboratory of Experimental Neuroscience (LANEX), University of Southern Catarina (UNISUL), Palhoça, Santa Catarina, Brazil
- Post-Graduate Program in Health Sciences, University of Southern Catarina (UNISUL), Palhoça, Santa Catarina, Brazil
| | - Débora C Martins
- Laboratory of Experimental Neuroscience (LANEX), University of Southern Catarina (UNISUL), Palhoça, Santa Catarina, Brazil
- Medicine Degree Course, University of Southern Catarina (UNISUL), Palhoça, Santa Catarina, Brazil
| | | | - Leandro Giacomello
- Laboratory of Experimental Neuroscience (LANEX), University of Southern Catarina (UNISUL), Palhoça, Santa Catarina, Brazil
- Post-Graduate Program in Health Sciences, University of Southern Catarina (UNISUL), Palhoça, Santa Catarina, Brazil
| | - Verônica V Horewicz
- Laboratory of Experimental Neuroscience (LANEX), University of Southern Catarina (UNISUL), Palhoça, Santa Catarina, Brazil
- Post-Graduate Program in Health Sciences, University of Southern Catarina (UNISUL), Palhoça, Santa Catarina, Brazil
| | - Daniel F Martins
- Laboratory of Experimental Neuroscience (LANEX), University of Southern Catarina (UNISUL), Palhoça, Santa Catarina, Brazil
- Post-Graduate Program in Health Sciences, University of Southern Catarina (UNISUL), Palhoça, Santa Catarina, Brazil
| | - Anna P Piovezan
- Laboratory of Experimental Neuroscience (LANEX), University of Southern Catarina (UNISUL), Palhoça, Santa Catarina, Brazil
- Post-Graduate Program in Health Sciences, University of Southern Catarina (UNISUL), Palhoça, Santa Catarina, Brazil
- Medicine Degree Course, University of Southern Catarina (UNISUL), Palhoça, Santa Catarina, Brazil
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Shaik RS, Yareeda S, Manne N. An Interesting Case of "Migratory" Complex Regional Pain Syndrome (CRPS)! Ann Indian Acad Neurol 2023; 26:803-806. [PMID: 38022441 PMCID: PMC10666875 DOI: 10.4103/aian.aian_540_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 07/18/2023] [Accepted: 07/19/2023] [Indexed: 12/01/2023] Open
Affiliation(s)
- Reshma S. Shaik
- Department of Neurology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Sireesha Yareeda
- Department of Neurology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Narendhar Manne
- Department of Neurology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
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The Effectiveness of Rehabilitation Interventions on Pain and Disability for Complex Regional Pain Syndrome: A Systematic Review and Meta-analysis. Clin J Pain 2023; 39:91-105. [PMID: 36650605 DOI: 10.1097/ajp.0000000000001089] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 11/22/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVES To summarize and critically appraise the body of evidence on conservative management of complex regional pain syndrome (CRPS), we conducted a systematic review and meta-analysis of randomized controlled trials (RCTs). METHODS We conducted a literature search from inception to November 2021 in the following databases: Embase, Medline, CINAHL, Google Scholar, PEDRO, and Psychinfo. Two independent reviewers conducted risk of bias and quality assessment. Qualitative synthesis and meta-analysis were the methods for summarizing the findings of the RCTs. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach was used to rate the overall quality and certainty of the evidence on each treatment outcome. RESULT Through a database search, 751 records were found, and 33 RCTs were eligible for inclusion. Studies were published between 1995 and 2021. The overall risk of bias for 2 studies was low, 8 studies were unclear, and 23 studies were high.Low-quality evidence suggests that mirror therapy (as an addition to conventional stroke rehabilitation interventions) and graded motor imagery program (compared with routine rehabilitation interventions) may result in a large improvement in pain and disability up to 6-month follow-up in poststroke CRPS-1 patients. Low-quality evidence suggests that pain exposure therapy and aerobic exercises as an additive treatment to physical therapy interventions may result in a large improvement in pain up to a 6-month follow-up. The evidence is very uncertain about the effect of all other targeted interventions over conventional physical therapy or sham treatments on pain and disability. DISCUSSION There is an ongoing need for high-quality studies to inform conservative management choices in CRPS.
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Relative Prevalence and Associated Factors of Complex Regional Pain Syndrome Type I in Patients with Radial Head Fractures Treated with Open Reduction and Internal Fixation: A Cross-Sectional Study. Pain Res Manag 2022; 2022:9214404. [PMID: 35646200 PMCID: PMC9135570 DOI: 10.1155/2022/9214404] [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: 01/05/2022] [Revised: 04/07/2022] [Accepted: 05/04/2022] [Indexed: 11/26/2022]
Abstract
Objective This cross-sectional study aimed to examine the incidence and associated factors of complex regional pain syndrome type I (CRPS I) in patients who underwent open reduction and internal fixation (ORIF) for radial head fractures. Methods The study enrolled 601 radial head fracture patients treated with ORIF, 523 of which completed the 1-year follow-up. The incidence of CRPS I in those patients was assessed using the Budapest criteria. Patients were then divided into 2 groups: patients with CRPS I (n = 28) and patients without CRPS I (n = 495). The patients' demographic and clinical data before the operation were prospectively collected by our team. Independent t-tests and χ2 tests were used as univariate analyses to compare the demographic and clinical data between the two groups. Meanwhile, multivariate regression analysis was conducted to identify the associated risk factors for CRPS I. Results The incidence of CRPS I in patients with radial head fractures treated with ORIF was 5.5% during the first year following surgery. Significant differences were observed in age, gender, type of trauma, modified Mason Classification, and depressive personality disorders. The logistic regression analysis revealed that the female gender, modified Mason type III fractures, and depressive patients were significantly more likely to develop CRPS I (p=0.021, 0.023, and 0.025, respectively). Conclusions The incidence of CRPS I among radial head fracture patients undergoing ORIF was 5.5%. In addition, early detection of CRPS I and providing adequate intervention will likely result in greater benefits for those patients.
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de Oliveira Galassi T, Fernandes PF, Salgado ASI, Cidral-Filho FJ, Piovezan AP, Lüdtke DD, Mack JM, Weber KA, Reed WR, Bobinski F, Martins DF. Preventive Supplementation of Omega-3 Reduces Pain and Pro-inflammatory Cytokines in a Mouse Model of Complex Regional Pain Syndrome Type I. Front Integr Neurosci 2022; 16:840249. [PMID: 35431823 PMCID: PMC9005766 DOI: 10.3389/fnint.2022.840249] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 03/04/2022] [Indexed: 01/14/2023] Open
Abstract
Complex regional pain syndrome type I (CRPS-I) is a condition that responds poorly to treatments. The role of omega-3 fatty acids in the treatment of inflammatory disorders is well described in the literature; however, few studies have evaluated its therapeutic benefits in different types of pain. We evaluated the potential antihyperalgesic and anti-inflammatory effects of preventive omega-3 supplementation in an animal model of CRPS-I. In experiment 1, Swiss female mice were supplemented for 30 days with omega-3 before the induction of the CRPS-I model and 14 days after. Mechanical hyperalgesia was evaluated at baseline and from the 4th to the 14th day after CPRS-I induction along with open field locomotor activity after 30 days of supplementation. In experiment 2, Swiss female mice were supplemented for 30 days with omega-3 and then subjected to the CRPS-I model. Twenty-four hours later the animals were euthanized, and tissue samples of the spinal cord and right posterior paw muscle were taken to measure pro-inflammatory cytokine TNF and IL-1β concentrations. Omega-3 supplementation produced antihyperalgesic and anti-inflammatory effects, as well as reducing pro-inflammatory cytokine concentrations, without altering the animals’ locomotion. No open field locomotor changes were found. The 30-day supplementation at the tested dose was effective in the CRPS-I model.
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Affiliation(s)
- Taynah de Oliveira Galassi
- Experimental Neuroscience Laboratory (LaNEx), Postgraduate Program in Health Sciences, University of Southern Santa Catarina - UNISUL, Palhoça, Brazil
| | - Paula Franson Fernandes
- Experimental Neuroscience Laboratory (LaNEx), Postgraduate Program in Health Sciences, University of Southern Santa Catarina - UNISUL, Palhoça, Brazil
| | - Afonso Shiguemi Inoue Salgado
- Experimental Neuroscience Laboratory (LaNEx), Postgraduate Program in Health Sciences, University of Southern Santa Catarina - UNISUL, Palhoça, Brazil
- Natural Quanta Wellness Center, Windermere, FL, United States
| | - Francisco José Cidral-Filho
- Experimental Neuroscience Laboratory (LaNEx), Postgraduate Program in Health Sciences, University of Southern Santa Catarina - UNISUL, Palhoça, Brazil
| | - Anna Paula Piovezan
- Experimental Neuroscience Laboratory (LaNEx), Postgraduate Program in Health Sciences, University of Southern Santa Catarina - UNISUL, Palhoça, Brazil
| | - Daniela Dero Lüdtke
- Experimental Neuroscience Laboratory (LaNEx), Postgraduate Program in Health Sciences, University of Southern Santa Catarina - UNISUL, Palhoça, Brazil
| | - Josiel Mileno Mack
- Experimental Neuroscience Laboratory (LaNEx), Postgraduate Program in Health Sciences, University of Southern Santa Catarina - UNISUL, Palhoça, Brazil
- Department of Medical Clinic, Graduate Program in Medical Sciences, Federal University of Santa Catarina - UFSC, Florianopolis, Brazil
| | - Kenneth A. Weber
- Division of Pain Medicine, Stanford School of Medicine, Palo Alto, CA, United States
| | - William R. Reed
- Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Franciane Bobinski
- Experimental Neuroscience Laboratory (LaNEx), Postgraduate Program in Health Sciences, University of Southern Santa Catarina - UNISUL, Palhoça, Brazil
| | - Daniel F. Martins
- Experimental Neuroscience Laboratory (LaNEx), Postgraduate Program in Health Sciences, University of Southern Santa Catarina - UNISUL, Palhoça, Brazil
- *Correspondence: Daniel F. Martins,
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Becker N, Deilmann A, Kowark P, Hildebrand F, Lichte P. [Complex regional pain syndrome-An interdisciplinary view from the surgical consultation]. Chirurg 2021; 93:819-828. [PMID: 34748027 DOI: 10.1007/s00104-021-01529-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/07/2021] [Indexed: 10/19/2022]
Abstract
Chronic pain disorders are common and have a substantial impact on the patients' daily life. The specific syndrome of complex regional pain syndrome (CRPS, Sudeck's disease) is comparatively rare and characterized by additional sensorimotor, vascular and trophic dysfunctions. The diagnosis is made based on the Budapest criteria and according to clinical symptoms. According to the German national guidelines, multimodal therapy includes drug, rehabilitative and psychosomatic approaches for the reduction of pain and restoration of functionality. Bisphosphonates, steroids and antiepileptic drugs are well-established as medicinal treatment but should always be used in combination with functional therapy. Interventional treatment options are reserved for patients with complicated and enduring symptoms and should be carried out in specialized centers. The course of the disease is highly individual and frequently requires a long-term interdisciplinary treatment.
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Affiliation(s)
- Nils Becker
- Klinik für Orthopädie, Unfall- und Wiederherstellungschirurgie, Universitätsklinikum RWTH Aachen, AöR, Pauwelsstraße 30, 52074, Aachen, Deutschland.
| | - Alexander Deilmann
- Klinik für Plastische Chirurgie, Hand- und Verbrennungschirurgie, Universitätsklinikum RWTH Aachen, Aachen, Deutschland
| | - Pascal Kowark
- Klinik für Anästhesiologie, Universitätsklinikum RWTH Aachen, Aachen, Deutschland
| | - Frank Hildebrand
- Klinik für Orthopädie, Unfall- und Wiederherstellungschirurgie, Universitätsklinikum RWTH Aachen, AöR, Pauwelsstraße 30, 52074, Aachen, Deutschland
| | - Philipp Lichte
- Klinik für Orthopädie, Unfall- und Wiederherstellungschirurgie, Universitätsklinikum RWTH Aachen, AöR, Pauwelsstraße 30, 52074, Aachen, Deutschland
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Sarridou D, Papadopoulou D, Paraskevopoulos T, Stavropoulou E. Successful treatment of complex regional pain syndrome type 1 of upper limb with cryoneurolysis of the stellate ganglion: A rare case report. Pain Pract 2021; 22:285-287. [PMID: 34528377 DOI: 10.1111/papr.13077] [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] [Received: 06/12/2021] [Revised: 08/18/2021] [Accepted: 09/08/2021] [Indexed: 11/26/2022]
Abstract
Complex regional pain syndrome type I (CRPS I) is a multifactorial condition that is related to neural damage, and leads to chronic neuropathic pain. Due to its multifactorial nature, there are many methods that have been recruited for its management. Most of them limit the symptoms to some degree, but the most effective of them so far seems to be blockade of the sympathetic innervation of the region. We present the case of a 71-year-old woman, with an upper limb fracture which was treated conservatively, and later on developed CRPS type I. Analgesic medications and pregabalin were ineffective in controlling her symptoms. Blockade of the stellate ganglion was performed with local anesthetic and dexamethasone. After the stellate ganglion blockade was marked as successful in relieving her symptoms, cryoneurolysis was performed which was very effective. There are not many cases that have been treated with cryoneurolysis, and this is what makes this case interesting.
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Affiliation(s)
- Despoina Sarridou
- Anesthesiology Department, General Hospital of Thessaloniki "George Papanikolaou", Thessaloniki, Greece
| | - Dimitra Papadopoulou
- Anesthesiology Department, KAT General Hospital and Trauma Center, Athens, Greece
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Firat M. Complex regional pain syndrome type 1 of the upper limb following glass cut of the third finger in a patient. JOURNAL OF ORTHOPEDICS, TRAUMATOLOGY AND REHABILITATION 2021. [DOI: 10.4103/jotr.jotr_4_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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El Hasbani G, Uthman I, Jawad AS. Is adhesive capsulitis of the shoulder a form of complex regional pain syndrome type I? Saudi Med J 2020; 41:1144-1145. [PMID: 33026058 PMCID: PMC7841508 DOI: 10.15537/smj.2020.10.25421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
[No Abstract Available].
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Affiliation(s)
- Georges El Hasbani
- Division of Rheumatology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon. E-mail.
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Gonçalves ECD, Vieira G, Gonçalves TR, Simões RR, Brusco I, Oliveira SM, Calixto JB, Cola M, Santos ARS, Dutra RC. Bradykinin Receptors Play a Critical Role in the Chronic Post-ischaemia Pain Model. Cell Mol Neurobiol 2020; 41:63-78. [PMID: 32222846 DOI: 10.1007/s10571-020-00832-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Accepted: 03/16/2020] [Indexed: 02/06/2023]
Abstract
Complex regional pain syndrome type-I (CRPS-I) is a chronic painful condition resulting from trauma. Bradykinin (BK) is an important inflammatory mediator required in acute and chronic pain response. The objective of this study was to evaluate the association between BK receptors (B1 and B2) and chronic post-ischaemia pain (CPIP) development in mice, a widely accepted CRPS-I model. We assessed mechanical and cold allodynia, and paw oedema in male and female Swiss mice exposed to the CPIP model. Upon induction, the animals were treated with BKR antagonists (HOE-140 and DALBK); BKR agonists (Tyr-BK and DABK); antisense oligonucleotides targeting B1 and B2 and captopril by different routes in the model (7, 14 and 21 days post-induction). Here, we demonstrated that treatment with BKR antagonists, by intraperitoneal (i.p.), intraplantar (i.pl.), and intrathecal (i.t.) routes, mitigated CPIP-induced mechanical allodynia and oedematogenic response, but not cold allodynia. On the other hand, i.pl. administration of BKR agonists exacerbated pain response. Moreover, a single treatment with captopril significantly reversed the anti-allodynic effect of BKR antagonists. In turn, the inhibition of BKRs gene expression in the spinal cord inhibited the nociceptive behaviour in the 14th post-induction. The results of the present study suggest the participation of BKRs in the development and maintenance of chronic pain associated with the CPIP model, possibly linking them to CRPS-I pathogenesis.
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Affiliation(s)
- Elaine C D Gonçalves
- Laboratory of Autoimmunity and Immunopharmacology, Department of Health Sciences, Campus Araranguá, Federal University of Santa Catarina, Araranguá, SC, 88906-072, Brazil.,Post-Graduate Program of Neuroscience, Center of Biological Sciences, Federal University of Santa Catarina, Florianópolis, SC, 88040-900, Brazil
| | - Graziela Vieira
- Laboratory of Autoimmunity and Immunopharmacology, Department of Health Sciences, Campus Araranguá, Federal University of Santa Catarina, Araranguá, SC, 88906-072, Brazil
| | - Tainara R Gonçalves
- Laboratory of Autoimmunity and Immunopharmacology, Department of Health Sciences, Campus Araranguá, Federal University of Santa Catarina, Araranguá, SC, 88906-072, Brazil
| | - Róli R Simões
- Laboratory of Neurobiology of Pain and Inflammation, Department of Physiological Sciences, Center of Biological Sciences, Universidade Federal de Santa Catarina, Florianópolis, SC, 88040-900, Brazil
| | - Indiara Brusco
- Graduate Program in Biological Sciences: Toxicological Biochemistry, Federal University of Santa Maria, Santa Maria, RS, 97105-900, Brazil
| | - Sara M Oliveira
- Graduate Program in Biological Sciences: Toxicological Biochemistry, Federal University of Santa Maria, Santa Maria, RS, 97105-900, Brazil
| | - João B Calixto
- Center of Innovation and Preclinical Research, Florianópolis, SC, 88056-000, Brazil
| | - Maíra Cola
- Laboratory of Autoimmunity and Immunopharmacology, Department of Health Sciences, Campus Araranguá, Federal University of Santa Catarina, Araranguá, SC, 88906-072, Brazil
| | - Adair R S Santos
- Laboratory of Neurobiology of Pain and Inflammation, Department of Physiological Sciences, Center of Biological Sciences, Universidade Federal de Santa Catarina, Florianópolis, SC, 88040-900, Brazil
| | - Rafael C Dutra
- Laboratory of Autoimmunity and Immunopharmacology, Department of Health Sciences, Campus Araranguá, Federal University of Santa Catarina, Araranguá, SC, 88906-072, Brazil. .,Post-Graduate Program of Neuroscience, Center of Biological Sciences, Federal University of Santa Catarina, Florianópolis, SC, 88040-900, Brazil. .,Laboratório de Autoimunidade e Imunofarmacologia (LAIF), Departamento de Ciências da Saúde, Universidade Federal de Santa Catarina, Campus Araranguá. Rodovia Jorge Lacerda, Km 35.4 - Jardim das Avenidas, Araranguá, SC, CEP 88906-072, Brazil.
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