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Chen Y, Nelson AM, Cohen SP. Chronic pain for rheumatological disorders: Pathophysiology, therapeutics and evidence. Joint Bone Spine 2024; 91:105750. [PMID: 38857874 DOI: 10.1016/j.jbspin.2024.105750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 05/20/2024] [Accepted: 05/22/2024] [Indexed: 06/12/2024]
Abstract
Pain is the leading reason people seek orthopedic and rheumatological care. By definition, most pain can be classified as nociceptive, or pain resulting from non-neural tissue injury or potential injury, with between 15% and 50% of individuals suffering from concomitant neuropathic pain or the newest category of pain, nociplastic pain, defined as "pain arising from altered nociception despite no clear evidence of actual or threatened tissue damage, or of a disease or lesion affecting the somatosensory system." Pain classification is important because it affects treatment decisions at all levels of care. Although several instruments can assist with classifying treatment, physician designation is the reference standard. The appropriate treatment of pain should ideally involve multidisciplinary care including physical therapy, psychotherapy and integrative therapies when appropriate, and pharmacotherapy with non-steroidal anti-inflammatory drugs for acute, mechanical pain, membrane stabilizers for neuropathic and nociplastic pain, and serotonin-norepinephrine reuptake inhibitors and tricyclic antidepressants for all types of pain. For nonsurgical interventions, there is evidence to support a small effect for epidural steroid injections for an intermediate-term duration, and conflicting evidence for radiofrequency ablation to provide at least 6months of benefit for facet joint pain, knee osteoarthritis, and sacroiliac joint pain. Since pain and disability represent the top reason for elective surgery, it should be reserved for patients who fail conservative interventions. Risk factors for procedural failure are the same as risk factors for conservative treatment failure and include greater disease burden, psychopathology, opioid use, central sensitization and multiple comorbid pain conditions, poorly controlled preoperative and postoperative pain, and secondary gain.
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Affiliation(s)
- Yian Chen
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA
| | - Ariana M Nelson
- Department of Anesthesiology and Perioperative Care, University of California-Irvine, Orange, CA, USA
| | - Steven P Cohen
- Departments of Anesthesiology, Physical Medicine & Rehabilitation, Neurology, Psychiatry and Neurosurgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA; Departments of Anesthesiology & Critical Care Medicine, Neurology, Physical Medicine & Rehabilitation and Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA; Departments of Physical Medicine & Rehabilitation and Anesthesiology, Walter Reed National Military Medical Center, Uniformed Services, University of the Health Sciences, Bethesda, MD,USA.
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2
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Masaud K, Collins JM, Rubio RC, Corrigan M, Cotter PD, O'Brien N, Bluett R, Jimenez CK, O'Mahony SM, Shorten GD. The gut microbiota in persistent post-operative pain following breast cancer surgery. Sci Rep 2024; 14:12401. [PMID: 38811609 PMCID: PMC11137075 DOI: 10.1038/s41598-024-62397-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 05/16/2024] [Indexed: 05/31/2024] Open
Abstract
Persistent post-surgical pain (PPSP) is defined as pain which continues after a surgical operation in a significant form for at least three months (and is not related to pre-existing painful conditions). PPSP is a common, under-recognised, and important clinical problem which affects millions of patients worldwide. Preventative measures which are currently available include the selection of a minimally invasive surgical technique and an aggressive multimodal perioperative analgesic regimen. More recently, a role for the gut microbiota in pain modulation has become increasingly apparent. This study aims to investigate any relationship between the gut microbiota and PPSP. A prospective observational study of 68 female adult patients undergoing surgery for management of breast cancer was carried out. Stool samples from 45 of these patients were obtained to analyse the composition of the gut microbiota. Measures of pain and state-trait anxiety were also taken to investigate further dimensions in any relationship between the gut microbiota and PPSP. At 12 weeks postoperatively, 21 patients (51.2%) did not have any pain and 20 patients (48.8%) reported feeling pain that persisted at that time. Analysis of the gut microbiota revealed significantly lower alpha diversity (using three measures) in those patients reporting severe pain at the 60 min post-operative and the 12 weeks post-operative timepoints. A cluster of taxa represented by Bifidobacterium longum, and Faecalibacterium prausnitzii was closely associated with those individuals reporting no pain at 12 weeks postoperatively, while Megamonas hypermegale, Bacteroides pectinophilus, Ruminococcus bromii, and Roseburia hominis clustered relatively closely in the group of patients fulfilling the criteria for persistent post-operative pain. We report for the first time specific associations between the gut microbiota composition and the presence or absence of PPSP. This may provide further insights into mechanisms behind the role of the gut microbiota in the development of PPSP and could inform future treatment strategies.
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Affiliation(s)
- Khaled Masaud
- Department of Anaesthesia and Intensive Care Medicine, Cork University Hospital and University College Cork, Cork, Ireland
| | - James M Collins
- APC Microbiome Ireland, University College Cork, Cork, Ireland
- Department of Anatomy and Neuroscience, University College Cork, Cork, Ireland
| | - Raul Cabrera Rubio
- APC Microbiome Ireland, University College Cork, Cork, Ireland
- Teagasc Food Research Centre, Moorepark, Fermoy, Cork, Ireland
- Department of Biotechnology, Institute of Agrochemistry and Food Technology-National Research Council (IATA-CSIC), Valencia, Spain
| | - Mark Corrigan
- Cork Breast Research Centre, University College Cork, Cork, Ireland
| | - Paul D Cotter
- APC Microbiome Ireland, University College Cork, Cork, Ireland
- Teagasc Food Research Centre, Moorepark, Fermoy, Cork, Ireland
| | - Niall O'Brien
- Department of Anaesthesia and Intensive Care Medicine, Cork University Hospital and University College Cork, Cork, Ireland
| | - Ronan Bluett
- Department of Anaesthesia and Intensive Care Medicine, Cork University Hospital and University College Cork, Cork, Ireland
| | - Clare Keaveney Jimenez
- Department of Anaesthesia and Intensive Care Medicine, Cork University Hospital and University College Cork, Cork, Ireland
| | - Siobhain M O'Mahony
- APC Microbiome Ireland, University College Cork, Cork, Ireland
- Department of Anatomy and Neuroscience, University College Cork, Cork, Ireland
| | - George D Shorten
- Department of Anaesthesia and Intensive Care Medicine, Cork University Hospital and University College Cork, Cork, Ireland.
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3
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Yu J, Wang S, Chen SJ, Zheng MJ, Yuan CR, Lai WD, Wen JJ, You WT, Liu PQ, Khanna R, Jin Y. Sinomenine ameliorates fibroblast-like synoviocytes dysfunction by promoting phosphorylation and nuclear translocation of CRMP2. JOURNAL OF ETHNOPHARMACOLOGY 2024; 324:117704. [PMID: 38176664 DOI: 10.1016/j.jep.2024.117704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 11/14/2023] [Accepted: 01/02/2024] [Indexed: 01/06/2024]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Rheumatoid arthritis (RA) is a chronic autoimmune disease characterized by synovial inflammation and arthritic pain. Sinomenine (SIN), derived from the rhizome of Chinese medical herb Qing Teng (scientific name: Sinomenium acutum (Thunb.) Rehd. Et Wils), has a longstanding use in Chinese traditional medicine for treating rheumatoid arthritis. It has been shown to possess anti-inflammatory, analgesic, and immunosuppressive effects with minimal side-effects clinically. However, the mechanisms governing its effects in treatment of joint pathology, especially on fibroblast-like synoviocytes (FLSs) dysfunction, and arthritic pain remains unclear. AIM This study aimed to investigate the effect and underlying mechanism of SIN on arthritic joint inflammation and joint FLSs dysfunctions. MATERIALS AND METHODS Collagen-induced arthritis (CIA) was induced in rats and the therapeutic effects of SIN on joint pathology were evaluated histopathologically. Next, we conducted a series of experiments using LPS-induced FLSs, which were divided into five groups (Naïve, LPS, SIN 10, 20, 50 μg/ml). The expression of inflammatory factors was measured by qPCR and ELISA. The invasive ability of cells was detected by modified Transwell assay and qPCR. Transwell migration and cell scratch assays were used to assess the migration ability of cells. The distribution and content of relevant proteins were observed by immunofluorescence and laser confocal microscopy, as well as Western Blot and qPCR. FLSs were transfected with plasmids (CRMP2 T514A/D) to directly modulate the post-translational modification of CRMP2 protein and downstream effects on FLSs function was monitored. RESULTS SIN alleviated joint inflammation in rats with CIA, as evidenced by improvement of synovial hyperplasia, inflammatory cell infiltration and cartilage damage, as well as inhibition of pro-inflammatory cytokines release from FLSs induced by LPS. In vitro studies revealed a concentration-dependent suppression of SIN on the invasion and migration of FLSs induced by LPS. In addition, SIN downregulated the expression of cellular CRMP2 that was induced by LPS in FLSs, but increased its phosphorylation at residue T514. Moreover, regulation of pCRMP2 T514 by plasmids transfection (CRMP2 T514A/D) significantly influenced the migration and invasion of FLSs. Finally, SIN promoted nuclear translocation of pCRMP2 T514 in FLSs. CONCLUSIONS SIN may exert its anti-inflammatory and analgesic effects by modulating CRMP2 T514 phosphorylation and its nuclear translocation of FLSs, inhibiting pro-inflammatory cytokine release, and suppressing abnormal invasion and migration. Phosphorylation of CRMP2 at the T514 site in FLSs may present a new therapeutic target for treating inflammatory joint's destruction and arthritic pain in RA.
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Affiliation(s)
- Jie Yu
- The Second Affiliated Hospital of Zhejiang Chinese Medical University, Xinhua Hospital of Zhejiang Province, Hangzhou, 310053, China; College of Basic Medical Science, Key Laboratory of Neuropharmacology and Translational Medicine of Zhejiang Province, Zhejiang Chinese Medical University, Hangzhou, 310058, China
| | - Song Wang
- College of Basic Medical Science, Key Laboratory of Neuropharmacology and Translational Medicine of Zhejiang Province, Zhejiang Chinese Medical University, Hangzhou, 310058, China
| | - Si-Jia Chen
- College of Basic Medical Science, Key Laboratory of Neuropharmacology and Translational Medicine of Zhejiang Province, Zhejiang Chinese Medical University, Hangzhou, 310058, China
| | - Meng-Jia Zheng
- College of Basic Medical Science, Key Laboratory of Neuropharmacology and Translational Medicine of Zhejiang Province, Zhejiang Chinese Medical University, Hangzhou, 310058, China
| | - Cun-Rui Yuan
- College of Basic Medical Science, Key Laboratory of Neuropharmacology and Translational Medicine of Zhejiang Province, Zhejiang Chinese Medical University, Hangzhou, 310058, China
| | - Wei-Dong Lai
- The Second Affiliated Hospital of Zhejiang Chinese Medical University, Xinhua Hospital of Zhejiang Province, Hangzhou, 310053, China; College of Basic Medical Science, Key Laboratory of Neuropharmacology and Translational Medicine of Zhejiang Province, Zhejiang Chinese Medical University, Hangzhou, 310058, China
| | - Jun-Jun Wen
- The Second Affiliated Hospital of Zhejiang Chinese Medical University, Xinhua Hospital of Zhejiang Province, Hangzhou, 310053, China; College of Basic Medical Science, Key Laboratory of Neuropharmacology and Translational Medicine of Zhejiang Province, Zhejiang Chinese Medical University, Hangzhou, 310058, China
| | - Wen-Ting You
- Department of Pharmacy, The Affiliated Wenling Hospital of Wenzhou Medical University, Wenling, 317500, China
| | - Pu-Qing Liu
- The Second Affiliated Hospital of Zhejiang Chinese Medical University, Xinhua Hospital of Zhejiang Province, Hangzhou, 310053, China
| | - Rajesh Khanna
- Department of Molecular Pathobiology, New York University, College of Dentistry, and NYU Pain Research Center, New York, 10010, USA.
| | - Yan Jin
- The Second Affiliated Hospital of Zhejiang Chinese Medical University, Xinhua Hospital of Zhejiang Province, Hangzhou, 310053, China; College of Basic Medical Science, Key Laboratory of Neuropharmacology and Translational Medicine of Zhejiang Province, Zhejiang Chinese Medical University, Hangzhou, 310058, China.
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Chaabo K, Chan E, Garrood T, Rutter-Locher Z, Vincent A, Galloway J, Norton S, Kirkham BW. Pain sensitisation and joint inflammation in patients with active rheumatoid arthritis. RMD Open 2024; 10:e003784. [PMID: 38508678 PMCID: PMC10953307 DOI: 10.1136/rmdopen-2023-003784] [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: 10/04/2023] [Accepted: 02/08/2024] [Indexed: 03/22/2024] Open
Abstract
INTRODUCTION Despite better therapies and strategies, many people with rheumatoid arthritis (RA) have persistent pain, often from abnormal pain processing, now termed nociplastic pain. However, RA patients with fibromyalgia (FM), a central nociplastic pain syndrome, also have power doppler ultrasound (PDUS+) joint inflammation. To understand the complex causes of pain, we performed clinical examination and patient-reported outcome measures (PROMs) plus comprehensive PDUS evaluation not previously combined. METHODS In a cross-sectional study of sequential RA patients with at least moderate DAS28 erythrocyte sedimentation rate disease activity, we assessed 66/68 joints for swelling and tenderness, respectively, FM American College of Rheumatology 2010 diagnostic criteria, completed PROMs for function, quality of life and mood, alongside PDUS examination of 44 joints. Statistical analysis included logistic regression modelling and regularised (lasso) logistic regression methods. RESULTS From 158 patients, 72 (46%) patients met FM criteria, with significantly worse tender joint counts and PROMs, but no differences in PDUS compared with the non-FM group. Categorising patients by PDUS+ joint presence and/or FM criteria, we identified four distinct groups: 43 (27.2%) patients with -FM-PD, 43 (27.2%) with -FM+PD, 42 (26.6%) with +FM-PD and 30 (19%) with +FM+PD. Both FM+ groups had worse PROMs for fatigue, mood and pain, compared with the FM- groups. We were unable to develop algorithms to identify different groups. CONCLUSION The unexpected group -FM-PD group may have peripheral nociplastic pain, not commonly recognised in rheumatology. Only 46% of patients demonstrated PDUS+ inflammation. However clinical examination and PROMs did not reliably differentiate groups, emphasising PDUS remains an important tool.
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Affiliation(s)
- Khaldoun Chaabo
- Rheumatology, Guy's and St Thomas' Hospitals NHS Trust, London, UK
| | - Estee Chan
- Rheumatology, Guy's and St Thomas' Hospitals NHS Trust, London, UK
| | - Toby Garrood
- Rheumatology, Guy's and St Thomas' Hospitals NHS Trust, London, UK
| | | | - Alex Vincent
- Guy's and St Thomas' Hospitals NHS Trust, London, UK
| | - James Galloway
- Academic Department of Rheumatology, King's College London, London, UK
| | - Sam Norton
- Academic Department of Rheumatology, King's College London, London, UK
| | - Bruce W Kirkham
- Rheumatology, Guy's and St Thomas' Hospitals NHS Trust, London, UK
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Del Gaudio MP, Kraus SI, Melzer TM, Bustos PS, Ortega MG. Oral treatment with Berberine reduces peripheral nociception: Possible interaction with different nociceptive pathways activated by different allogeneic substances. JOURNAL OF ETHNOPHARMACOLOGY 2024; 321:117504. [PMID: 38061440 DOI: 10.1016/j.jep.2023.117504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Revised: 11/20/2023] [Accepted: 11/22/2023] [Indexed: 12/30/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Berberine was identified in extracts of Berberis ruscifolia Lam., a plant used in traditional medicine as an analgesic. Its presence may be involved in the reported pharmacological activity of this species. However, there is still a lack of scientific research concerning its analgesic activity in the peripheral nervous system. AIM OF THE STUDY To investigate Berb-induced antinociception in the formalin test and to evaluate several pathways related to its pharmacological antinociceptive effects in chemical models of nociception in mice. MATERIALS AND METHODS The antinociceptive activity of Berb was assessed by inducing the paw licking in mice with different allodynic agents. In the formalin test, the antiedematous and antithermal effect of Berb was evaluated simultaneously in the same experiment. Other nociceptive behavior produced by endogenous [prostaglandin E2 (PGE2), histamine (His), glutamate (Glu) or bradykinin (BK)] or exogenous [capsaicin (Caps) and cinnamaldehyde (Cin)] chemical stimuli, and activators as protein kinase A (PKA) and C (PKC), were also evaluated.The in vivo doses for p.o. were 3 and 30 mg/kg. RESULTS Berb, at 30 mg/kg p.o., showed a significant inhibition of the nociceptive action in formalin in both phases being stronger at the inflammatory phase (59 ± 9%) and more active than Asp (positive control) considering the doses evaluated. Moreover, Berb inhibited the edema (34 ± 10%), but not the temperature in the formalin test. Regarding the different nociceptive signaling pathways evaluated, the most relevant data were that the administration of p.o. of Berb, at 30 mg/kg, caused significant inhibition of nociception induced by endogenous [His (72 ± 11%), PGE2 (78 ± 4%), and BK (51 ± 7%)], exogenous [Cap (68 ± 4%) and Cinn (57 ± 5%)] compounds, and activators of the PKA [(FSK (86 ± 3%)] and PKC [(PMA(86 ± 6%)] signaling pathway. Berb did not inhibit the nociceptive effect produced by Glu. CONCLUSION The present study demonstrated, for the first time, the potential of Berb in several nociceptive tests, with the compound present in B. ruscifolia contributing to the analgesic effect reported for this species.
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Affiliation(s)
- Micaela Paula Del Gaudio
- Departamento de Ciencias Farmacéuticas, Facultad de Ciencias Químicas, Universidad Nacional de Córdoba, Haya de la Torre y Medina Allende, Córdoba, 5000, Argentina; Instituto Multidisciplinario de Biología Vegetal (IMBIV), Consejo Nacional de Investigaciones Científicas y Tecnológicas (CONICET), Universidad Nacional de Córdoba, Av. Vélez Sarsfield 1611, Córdoba, 5000, Argentina
| | - Scheila Iria Kraus
- Laboratory of Neurobiology of Pain and Inflammation, Department of Physiological Sciences, Center for Biological Sciences, Federal University of Santa Catarina, University Campus, Trindade, Florianópolis, SC, 88040-900, Brazil
| | - Thayza Martins Melzer
- Laboratory of Neurobiology of Pain and Inflammation, Department of Physiological Sciences, Center for Biological Sciences, Federal University of Santa Catarina, University Campus, Trindade, Florianópolis, SC, 88040-900, Brazil
| | - Pamela Soledad Bustos
- Departamento de Ciencias Farmacéuticas, Facultad de Ciencias Químicas, Universidad Nacional de Córdoba, Haya de la Torre y Medina Allende, Córdoba, 5000, Argentina; Instituto Multidisciplinario de Biología Vegetal (IMBIV), Consejo Nacional de Investigaciones Científicas y Tecnológicas (CONICET), Universidad Nacional de Córdoba, Av. Vélez Sarsfield 1611, Córdoba, 5000, Argentina
| | - María Gabriela Ortega
- Departamento de Ciencias Farmacéuticas, Facultad de Ciencias Químicas, Universidad Nacional de Córdoba, Haya de la Torre y Medina Allende, Córdoba, 5000, Argentina; Instituto Multidisciplinario de Biología Vegetal (IMBIV), Consejo Nacional de Investigaciones Científicas y Tecnológicas (CONICET), Universidad Nacional de Córdoba, Av. Vélez Sarsfield 1611, Córdoba, 5000, Argentina.
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Erlenwein J, Petzke F, Tavernini T, Heindl LM, Feltgen N. [Chronic eye pain]. DIE OPHTHALMOLOGIE 2023; 120:1216-1225. [PMID: 37999754 DOI: 10.1007/s00347-023-01957-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/02/2023] [Indexed: 11/25/2023]
Abstract
Numerous conditions in the field of ophthalmology are associated with pain in or around the eye. Chronic pain associated with the eye is a common finding in the daily routine of ophthalmologists and can be associated with primary ocular or extraocular diseases as well as with other conditions. Appropriate diagnostic assessment and management of people with chronic pain requires an understanding of the condition based on the biopsychosocial model in which the interactions of biological/somatic, psychological and social factors are determining pain and suffering. Beyond the ophthalmological findings, close interdisciplinary cooperation and assessment are required. Therefore, if eye pain is insufficiently responsive to treatment or if symptoms of chronic pain are evident, pain medicine expertise should be involved. The management of chronic ocular pain is based on interdisciplinary multimodal approaches, in addition to the ophthalmologist-specific approaches. These focus on self-efficacy, patient competence and acceptance of pain as central goals of treatment rather than pain relief. Patient information, education and the development of a suitable concept by the interdisciplinary team are essential therapeutic aspects in this context.
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Affiliation(s)
- Joachim Erlenwein
- Klinik für Anästhesiologie, Universitätsmedizin Göttingen, Robert Koch Str. 40, 37075, Göttingen, Deutschland.
| | - Frank Petzke
- Klinik für Anästhesiologie, Universitätsmedizin Göttingen, Robert Koch Str. 40, 37075, Göttingen, Deutschland
| | - Tabea Tavernini
- Interdisziplinäres Schmerzzentrum, DIAKOVERE Friederikenstift, Hannover, Deutschland
| | - Ludwig M Heindl
- Zentrum für Augenheilkunde, Medizinische Fakultät und Uniklinik Köln, Universität zu Köln, Köln, Deutschland
- Centrum für Integrierte Onkologie (CIO), Aachen-Bonn-Köln-Düsseldorf, Köln, Deutschland
| | - Nicolas Feltgen
- Augenklinik, Universitätsmedizin Göttingen, Göttingen, Deutschland
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de Lima Silva MG, Santos da Silva LY, Torres Pessoa R, de Oliveira MRC, Batista FLA, Alcântara IS, Bezerra Martins AOBP, Ribeiro-Filho J, Coutinho HDM, de Menezes IRA. Antiedematogenic and Analgesic Activities of Abietic Acid in Mice. Chem Biodivers 2023; 20:e202300906. [PMID: 37795905 DOI: 10.1002/cbdv.202300906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 10/02/2023] [Accepted: 10/05/2023] [Indexed: 10/06/2023]
Abstract
Exacerbated inflammatory responses to harmful stimuli can lead to significant pain, edema, and other complications that require pharmacological intervention. Abietic acid (AA) is a diterpene found as a significant constituent in pine species, and evidence has identified its biological potential. The present study aimed to evaluate abietic acid's antiedematogenic and anti-inflammatory activity in mice. Swiss mice (Mus musculus) weighing 20-30 g were treated with AA at 50, 100, and 200 mg/kg. The central nervous system (CNS) effects were evaluated using open-field and rotarod assays. The antinociceptive and anti-inflammatory screening was assessed by the acetic acid and formalin tests. The antiedematogenic activity was investigated by measuring paw edema induced by carrageenan, dextran, histamine, arachidonic acid, and prostaglandin, in addition to using a granuloma model. The oral administration of abietic acid (200 mg/Kg) showed no evidence of CNS effects. The compound also exhibited significant antiedematogenic and anti-inflammatory activities in the carrageenan and dextran models, mostly related to the inhibition of myeloperoxidase (MOP) activity and histamine action and, to a lesser extent, the inhibition of eicosanoid-dependent pathways. In the granuloma model, abietic acid's effect was less expressive than in the acute models investigated in this study. In conclusion, abietic acid has analgesic and antiedematogenic activities related to anti-inflammatory mechanisms.
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Affiliation(s)
- Maria Gabriely de Lima Silva
- Laboratory of Pharmacology and Molecular Chemistry (LFQM), Department of Biological Chemistry, Regional University of Cariri (URCA), Crato, CE-63105-000, Brazil
| | - Lucas Yure Santos da Silva
- Laboratory of Pharmacology and Molecular Chemistry (LFQM), Department of Biological Chemistry, Regional University of Cariri (URCA), Crato, CE-63105-000, Brazil
| | - Renata Torres Pessoa
- Laboratory of Pharmacology and Molecular Chemistry (LFQM), Department of Biological Chemistry, Regional University of Cariri (URCA), Crato, CE-63105-000, Brazil
| | - Maria Rayane Correia de Oliveira
- Laboratory of Pharmacology and Molecular Chemistry (LFQM), Department of Biological Chemistry, Regional University of Cariri (URCA), Crato, CE-63105-000, Brazil
| | - Francisco Lucas Alves Batista
- Laboratory of Pharmacology and Molecular Chemistry (LFQM), Department of Biological Chemistry, Regional University of Cariri (URCA), Crato, CE-63105-000, Brazil
| | - Isabel Sousa Alcântara
- Laboratory of Pharmacology and Molecular Chemistry (LFQM), Department of Biological Chemistry, Regional University of Cariri (URCA), Crato, CE-63105-000, Brazil
| | | | - Jaime Ribeiro-Filho
- Oswaldo Cruz Foundation (Fiocruz), Fiocruz Ceará, Eusébio, CE-60180-900, Brazil
| | - Henrique Douglas Melo Coutinho
- Laboratory of Microbiology and Molecular Biology, Department of Biological Chemistry, Regional University of Cariri (URCA), Crato, CE-63105-000, Brazil
| | - Irwin Rose Alencar de Menezes
- Laboratory of Pharmacology and Molecular Chemistry (LFQM), Department of Biological Chemistry, Regional University of Cariri (URCA), Crato, CE-63105-000, Brazil
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Vinyes D, Muñoz-Sellart M, Fischer L. Therapeutic Use of Low-Dose Local Anesthetics in Pain, Inflammation, and Other Clinical Conditions: A Systematic Scoping Review. J Clin Med 2023; 12:7221. [PMID: 38068272 PMCID: PMC10707454 DOI: 10.3390/jcm12237221] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 11/15/2023] [Accepted: 11/18/2023] [Indexed: 08/13/2024] Open
Abstract
The use of low-dose local anesthetics (LAs) has significantly transformed patient care by providing rapid and effective relief of pain and other clinical conditions while minimizing recovery time. This study aims to identify and describe the existing scientific evidence on the therapeutic use of low-dose LAs in various conditions and to identify gaps in the current literature in order to prioritize future research. This systematic scoping review adhered to the methodological guidelines outlined in the Arksey and O'Malley framework, which includes five distinct stages. Of the 129 studies included, 37.98% (n = 49) were clinical trials, 55.03% (n = 71) were observational studies, and 6.97% (n = 9) were systematic reviews. The most commonly reported indication for the use of low-dose LAs was chronic pain management (72.86%), followed by acute pain management (13.17%). Additionally, non-pain-related indications were also identified (13.95%). Overall, the administration of low-dose, short-acting LAs demonstrated favorable outcomes in terms of pain management and reduction in anxiety and depression scales, thereby having a positive impact on the patients' quality of life. This review represents the first systematic scoping review regarding the therapeutic role of LAs. To substantiate the reported positive effects on efficacy and safety, further rigorous research comprising larger, well-designed randomized controlled trials (RCTs) and long-term outcome monitoring is imperative.
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Affiliation(s)
- David Vinyes
- Institute of Neural Therapy and Regulatory Medicine, 08202 Sabadell, Spain;
- Master of Permanent Training in Medical and Dental Neural Therapy, University of Barcelona—IL3, 08018 Barcelona, Spain
- Neural Therapy Research Foundation, 08202 Sabadell, Spain
| | - Montserrat Muñoz-Sellart
- Institute of Neural Therapy and Regulatory Medicine, 08202 Sabadell, Spain;
- Master of Permanent Training in Medical and Dental Neural Therapy, University of Barcelona—IL3, 08018 Barcelona, Spain
- Neural Therapy Research Foundation, 08202 Sabadell, Spain
| | - Lorenz Fischer
- Formerly Neural Therapy, Institute of Complementary and Integrative Medicine (IKIM), University of Bern, 3012 Bern, Switzerland;
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Halvey E, Haslam N, Mariano E. Non-steroidal anti-inflammatory drugs in the perioperative period. BJA Educ 2023; 23:440-447. [PMID: 37876761 PMCID: PMC10591119 DOI: 10.1016/j.bjae.2023.08.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/02/2023] [Indexed: 10/26/2023] Open
Affiliation(s)
- E.J. Halvey
- Sir Charles Gairdner Hospital, Perth, Australia
| | - N. Haslam
- South Tyneside and Sunderland Foundation Trust, Sunderland, UK
| | - E.R. Mariano
- Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
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Murakami T, Ishida T, Tanaka S, Nakayama J, Tsurugizawa T, Takahashi Y, Kato F, Kawamata M. Inflammation and subsequent nociceptor sensitization in the bone marrow are involved in an animal model of osteoarthritis pain. Life Sci 2023; 324:121736. [PMID: 37121542 DOI: 10.1016/j.lfs.2023.121736] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 04/21/2023] [Accepted: 04/23/2023] [Indexed: 05/02/2023]
Abstract
AIMS This study aimed to determine whether pathological changes in the bone marrow cause Osteoarthritis (OA) pain based on magnetic resonance imaging (MRI), immunohistochemistry, and electrophysiology. MAIN METHODS Adjuvant-induced arthritis (AIA) was achieved by injecting 150 μL of complete Freund's adjuvant into the right knee joints of male Sprague-Dawley rats. AIA rats were compared with saline-injected rats. KEY FINDINGS AIA significantly induced mechanical hyperalgesia and spontaneous pain in the right hind paw 1-14 days after induction. Intratibial injection of 50 μL of 1 % lidocaine significantly suppressed AIA-induced mechanical hyperalgesia (p = 0.0001) and spontaneous pain (p = 0.0006) 3 days after induction. In T2-weighted MRI, AIA induced high-signal intensity within the proximal tibial metaphysis, and the mean T2 values in this area significantly increased on days 3 (p = 0.0043) and 14 (p = 0.0012) after induction. AIA induced intraosseous edema and significantly increased the number of intraosseous granulocytes on days 3 (p < 0.0001) and 14 (p < 0.0001) after induction. The electrophysiological study on days 3-7 after induction showed significantly increased spontaneous firing rates (p = 0.0166) and evoked responses to cutaneous stimuli (brush, p < 0.0001; pinching, p = 0.0359) in the right hind paw plantar surface and intratibial stimuli (p = 0.0002) in wide-dynamic-range neurons of the spinal dorsal horn. SIGNIFICANCE Intraosseous changes caused by OA induce hypersensitivity in the sensory afferents innervating bone marrow may be involved in OA pain. Novel bone marrow-targeted therapies could be beneficial for treating OA pain.
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Affiliation(s)
- Toru Murakami
- Department of Anesthesiology and Resuscitology, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Takashi Ishida
- Department of Anesthesiology and Resuscitology, Shinshu University School of Medicine, Matsumoto, Nagano, Japan.
| | - Satoshi Tanaka
- Department of Anesthesiology and Resuscitology, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Jun Nakayama
- Department of Molecular Pathology, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Tomokazu Tsurugizawa
- Human Informatics and Interaction Research Institute, National Institute of Advanced Industrial Science and Technology (AIST), Tsukuba, Ibaraki, Japan
| | - Yukari Takahashi
- Center for Neuroscience of Pain and Department of Neuroscience, The Jikei University School of Medicine, Tokyo, Japan
| | - Fusao Kato
- Center for Neuroscience of Pain and Department of Neuroscience, The Jikei University School of Medicine, Tokyo, Japan
| | - Mikito Kawamata
- Department of Anesthesiology and Resuscitology, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
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Ohashi Y, Uchida K, Fukushima K, Inoue G, Takaso M. Mechanisms of Peripheral and Central Sensitization in Osteoarthritis Pain. Cureus 2023; 15:e35331. [PMID: 36846635 PMCID: PMC9949992 DOI: 10.7759/cureus.35331] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2023] [Indexed: 02/24/2023] Open
Abstract
Pain, the primary symptom of osteoarthritis (OA), reduces both the quality and quantity of life for patients. The pathophysiology of OA pain is complex and often difficult to explain solely by radiological structural changes. One reason for this discrepancy is pain sensitization (peripheral sensitization [PS] and central sensitization [CS]) in OA. Thus, an understanding of pain sensitization is important when considering treatment strategies and development for OA pain. In recent years, pro-inflammatory cytokines, nerve growth factors (NGFs), and serotonin have been identified as causative agents that induce peripheral and central sensitization and are becoming therapeutic targets for OA pain. However, the characteristics of the clinical manifestations of pain sensitization elicited by these molecules remain unclear, and it is not well understood who among OA patients should receive the therapeutic intervention. Thus, this review summarizes evidence on the pathophysiology of peripheral and central sensitization in OA pain and the clinical features and treatment options for this condition. While the majority of the literature supports the existence of pain sensitization in chronic OA pain, clinical identification and treatment of pain sensitization in OA are still in their infancy, and future studies with good methodological quality are needed.
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Affiliation(s)
- Yoshihisa Ohashi
- Department of Orthopaedic Surgery, Kitasato University School of Medicine, Sagamihara, JPN
| | - Kentaro Uchida
- Department of Orthopaedic Surgery, Kitasato University School of Medicine, Sagamihara, JPN
| | - Kensuke Fukushima
- Department of Orthopaedic Surgery, Kitasato University School of Medicine, Sagamihara, JPN
| | - Gen Inoue
- Department of Orthopaedic Surgery, Kitasato University School of Medicine, Sagamihara, JPN
| | - Masashi Takaso
- Department of Orthopaedic Surgery, Kitasato University School of Medicine, Sagamihara, JPN
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12
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Finamor F, Scarabelot VL, Medeiros LF, Stein DJ, da Silva MD, Callai E, Caumo W, de Souza A, Torres ILS. Involvement of GABAergic, glutamatergic, opioidergic, and brain-derived neurotrophic factor systems in the trigeminal neuropathic pain process. Neurosci Lett 2023; 793:136970. [PMID: 36402255 DOI: 10.1016/j.neulet.2022.136970] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 11/11/2022] [Accepted: 11/14/2022] [Indexed: 11/18/2022]
Abstract
Trigeminal neuropathic pain (TNP) is an intense pain condition characterized by hyperalgesia and allodynia; however, its neural mechanisms are not completely understood. Its management is complex, and studies that investigate its biochemical mechanisms are important for improving clinical approaches. This study aimed to evaluate the involvement of GABAergic, glutamatergic, and opioidergic systems and brain-derived neurotrophic factor (BDNF) levels in the TNP process in rats. TNP is induced by chronic constriction injury of the infraorbital nerve (CCI-ION). Nociceptive responses were evaluated using the facial von Frey test before and after the administration of GABAergic and opioidergic agonists and glutamatergic antagonists. The rats were divided into vehicle-treated control (C), sham-surgery (SS), and CCI-ION groups, and then subdivided into the vehicle (V)-treated SS-V and CCI-ION-V groups, SS-MK801 and CCI-ION-MK801, treated with the N-methyl-d-aspartate receptor selective antagonist MK801; SS-PB and CCI-ION-PB, treated with phenobarbital; SS-BZD and CCI-ION-BZD, treated with diazepam; SS-MOR and CCI-ION-MOR, treated with morphine. BDNF levels were evaluated in the cerebral cortex, brainstem, trigeminal ganglion, infraorbital branch of the trigeminal nerve, and serum. CCI-ION induced facial mechanical hyperalgesia. Phenobarbital and morphine reversed the hyperalgesia induced by CCI-ION, and the CCI-BZD group had an increased nociceptive threshold until 60 min. CCI-ION-GLU increased the nociceptive threshold at 60 min. Cerebral cortex and brainstem BDNF levels increased in the CCI-ION and SS groups. Only the CCI group presented high levels of BDNF in the trigeminal ganglion. Our data suggest the involvement of GABAergic, glutamatergic, and opioidergic systems and peripheral BDNF in the TNP process.
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Affiliation(s)
- Fabrício Finamor
- Nucleus of Pain Pharmacology and Neuromodulation. Hospital de Clínicas de Porto Alegre, RS, Brazil
| | - Vanessa Leal Scarabelot
- Nucleus of Pain Pharmacology and Neuromodulation. Hospital de Clínicas de Porto Alegre, RS, Brazil
| | - Liciane Fernandes Medeiros
- Nucleus of Pain Pharmacology and Neuromodulation. Hospital de Clínicas de Porto Alegre, RS, Brazil; Universidade La Salle, Canoas, RS, Brazil
| | - Dirson João Stein
- Nucleus of Pain Pharmacology and Neuromodulation. Hospital de Clínicas de Porto Alegre, RS, Brazil; School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Morgana Duarte da Silva
- Nucleus of Pain Pharmacology and Neuromodulation. Hospital de Clínicas de Porto Alegre, RS, Brazil
| | - Etiane Callai
- Nucleus of Pain Pharmacology and Neuromodulation. Hospital de Clínicas de Porto Alegre, RS, Brazil
| | - Wolnei Caumo
- Nucleus of Pain Pharmacology and Neuromodulation. Hospital de Clínicas de Porto Alegre, RS, Brazil; School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Andressa de Souza
- School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Iraci L S Torres
- Nucleus of Pain Pharmacology and Neuromodulation. Hospital de Clínicas de Porto Alegre, RS, Brazil; School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil.
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13
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Ayanaw MA, Yesuf JS, Birru EM. Evaluation of Analgesic and Anti-inflammatory Activities of Methanolic Leaf and Root Extracts of Gomphocarpus purpurascens A. Rich (Asclepiadaceae) in Mice. J Exp Pharmacol 2023; 15:1-11. [PMID: 36643970 PMCID: PMC9838122 DOI: 10.2147/jep.s361194] [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: 03/19/2022] [Accepted: 12/24/2022] [Indexed: 01/11/2023] Open
Abstract
Background Regardless of the availability of drugs many people still experienced pain and inflammation because current medications often trigger potentially serious adverse effects. A range of medicinal plants with analgesic and anti-inflammatory properties have been widely used by traditional healers. Among them, Gomphocarpus purpurascens is one however there are no experimental studies that support this traditional use. Objective This study aimed to evaluate the analgesic and anti-inflammatory activities of 80% methanolic leaf and root extracts of G. purpurascens. Methods Air-dried leaves and roots of G. purpurascens were extracted with 80% methanol and an acute oral toxicity study was conducted for the 80% methanolic extract of G. purpurascens according to OECD guideline version eighteen. Preliminary phytochemical screening for the presence of different constituents was carried out. The hot plate method was used to evaluate centrally mediated analgesic activity while peripheral analgesic activity was tested by an acetic acid-induced writhing test. Carrageenan-induced paw edema test and formalin-induced pedal edema test were used to evaluate anti-inflammatory activity. Results Dose-dependent inhibition of acetic acid-induced writhing test was observed in mice by 100 mg/kg, 200 mg/kg, and 400 mg/kg of root extract with respective values of 16.6%, 68.9%, and 83%. In the hot plate method, the root extract at doses of 200mg/kg and 400 mg/kg showed a significant (p < 0.05) analgesic effect. Maximum anti-inflammatory effects by all doses of leaf extracts were observed from 2-4hr post-induction in carrageenan-induced paw edema; and all tested doses of the extract inhibited the formalin-induced inflammation significantly (p < 0.001, p < 0.01). The presence of saponins, alkaloids, flavonoids, tannins, terpenoids, anthraquinone, steroids, and phenols might be responsible for these activities. Conclusion This study shows that the extract had potential analgesic and anti-inflammatory activity which supports the traditional claim.
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Affiliation(s)
- Meaza Adugna Ayanaw
- Department of Pharmacology, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia,Correspondence: Meaza Adugna Ayanaw, Tel +251 962818585, Email
| | - Jibril Seid Yesuf
- Department of Pharmacology, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Eshetie Melese Birru
- Department of Pharmacology, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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14
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Schaible HG, König C, Ebersberger A. Spinal pain processing in arthritis: Neuron and glia (inter)actions. J Neurochem 2022. [PMID: 36520021 DOI: 10.1111/jnc.15742] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 12/02/2022] [Accepted: 12/06/2022] [Indexed: 12/23/2022]
Abstract
Diseases of joints are among the most frequent causes of chronic pain. In the course of joint diseases, the peripheral and the central nociceptive system develop persistent hyperexcitability (peripheral and central sensitization). This review addresses the mechanisms of spinal sensitization evoked by arthritis. Electrophysiological recordings in anesthetized rats from spinal cord neurons with knee input in a model of acute arthritis showed that acute spinal sensitization is dependent on spinal glutamate receptors (AMPA, NMDA, and metabotropic glutamate receptors) and supported by spinal actions of neuropeptides such as neurokinins and CGRP, by prostaglandins, and by proinflammatory cytokines. In several chronic arthritis models (including immune-mediated arthritis and osteoarthritis) spinal glia activation was observed to be coincident with behavioral mechanical hyperalgesia which was attenuated or prevented by intrathecal application of minocycline, fluorocitrate, and pentoxyfylline. Some studies identified specific pathways of micro- and astroglia activation such as the purinoceptor- (P2 X7 -) cathepsin S/CX3 CR1 pathway, the mobility group box-1 protein (HMGB1), and toll-like receptor 4 (TLR4) activation, spinal NFκB/p65 activation and others. The spinal cytokines TNF, interleukin-6, interleukin-1β, and others form a functional spinal network characterized by an interaction between neurons and glia cells which is required for spinal sensitization. Neutralization of spinal cytokines by intrathecal interventions attenuates mechanical hyperalgesia. This effect may in part result from local suppression of spinal sensitization and in part from efferent effects which attenuate the inflammatory process in the joint. In summary, arthritis evokes significant spinal hyperexcitability which is likely to contribute to the phenotype of arthritis pain in patients.
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Affiliation(s)
- Hans-Georg Schaible
- Institute of Physiology 1/Neurophysiology, Jena University Hospital, Friedrich-Schiller-University of Jena, Jena, Germany
| | - Christian König
- Institute of Physiology 1/Neurophysiology, Jena University Hospital, Friedrich-Schiller-University of Jena, Jena, Germany
| | - Andrea Ebersberger
- Institute of Physiology 1/Neurophysiology, Jena University Hospital, Friedrich-Schiller-University of Jena, Jena, Germany
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15
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Zhang W, Li C, Zhao C, Ji N, Luo F. Pre-incisional infiltration with ropivacaine plus dexamethasone palmitate emulsion for postoperative pain in patients undergoing craniotomy: study protocol for a prospective, randomized controlled trial. Trials 2022; 23:996. [PMID: 36510271 PMCID: PMC9743637 DOI: 10.1186/s13063-022-06936-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 11/15/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Post-craniotomy pain is a common occurrence which is associated with poor outcomes. Pre-emptive scalp infiltration with dexamethasone and ropivacaine has been proven effective in previous studies but with limited clinical significance. Dexamethasone palmitate emulsion (D-PAL) is a pro-drug incorporating dexamethasone into lipid microspheres with greater anti-inflammatory activity and fewer side effects than free dexamethasone. However, its effects in post-craniotomy pain management remain unknown. This study hypothesizes that pre-emptive scalp infiltration with ropivacaine plus D-PAL emulsion can achieve superior analgesic effects to ropivacaine alone in adult patients undergoing craniotomy. METHODS/DESIGN This is a single center, randomized controlled trial enrolling 130 patients scheduled for supratentorial craniotomy, which is expected to last longer than 4 h. We compare the efficacy and safety for postoperative pain relief of ropivacaine plus D-PAL group and ropivacaine alone group following pre-emptive scalp infiltration. Primary outcome will be pain Numerical Rating Scale at 24 h postoperatively. Secondary outcomes will include further analgesia evaluations and drug-related complications within a follow-up period of 3 months. DISCUSSION This is the first randomized controlled trial aiming to assess the possible benefits or disadvantages of D-PAL emulsion for incisional pain in craniotomy. It may provide an alternative to optimize pain outcome for neurosurgical patients. TRIAL REGISTRATION ClinicalTrials.gov (NCT04488315). Registered on 19 July 2020.
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Affiliation(s)
- Wei Zhang
- grid.24696.3f0000 0004 0369 153XDepartment of Day Surgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070 People’s Republic of China
| | - Chunzhao Li
- grid.24696.3f0000 0004 0369 153XDepartment of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, 100070 Beijing, People’s Republic of China
| | - Chunmei Zhao
- grid.24696.3f0000 0004 0369 153XDepartment of Day Surgery and Pain Management, Beijing Tiantan Hospital, Capital Medical University, 100070 Beijing, People’s Republic of China
| | - Nan Ji
- grid.24696.3f0000 0004 0369 153XDepartment of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, 100070 Beijing, People’s Republic of China
| | - Fang Luo
- grid.24696.3f0000 0004 0369 153XDepartment of Day Surgery and Pain Management, Beijing Tiantan Hospital, Capital Medical University, 100070 Beijing, People’s Republic of China
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16
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Han X, Ren T, Wang Y, Ji N, Luo F. Postoperative Analgesic Efficacy and Safety of Ropivacaine Plus Diprospan for Preemptive Scalp Infiltration in Patients Undergoing Craniotomy: A Prospective Randomized Controlled Trial. Anesth Analg 2022; 135:1253-1261. [PMID: 35313321 PMCID: PMC9640293 DOI: 10.1213/ane.0000000000005971] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND Preemptive injection of local anesthetics can prevent postoperative pain at the incision site, but the analgesic effect is insufficient and is maintained only for a relatively short period of time. Diprospan is a combination of quick-acting betamethasone sodium phosphate and long-acting betamethasone dipropionate. Whether Diprospan as an adjuvant to local anesthetic can achieve postcraniotomy pain relief has not been studied yet. METHODS This is a prospective, single-center, blinded, randomized, controlled clinical study, which included patients ages 18 and 64 years, with American Society of Anaesthesiologists (ASA) physical statuses of I to III, scheduled for elective supratentorial craniotomy. We screened patients for enrollment from September 3, 2019, to August 15, 2020. The final follow-up was completed on February 15, 2021. Eligible patients were randomly assigned to either the Diprospan group, who received incision-site infiltration of 0.5% ropivacaine plus Diprospan (n = 48), or the control group, who received 0.5% ropivacaine alone (n = 48), with a distribution ratio of 1:1. Primary outcome was the cumulative sufentanil (μg) consumption through patient-controlled analgesia (PCA) within 48 hours after surgery. Primary analysis was performed based on the intention-to-treat (ITT) principle. RESULTS Baseline characteristics were not significantly different between the 2 groups ( P > .05). In the Diprospan group, the cumulative sufentanil consumption through PCA was 5 (0-16) µg within 48 hours postoperatively, which was significantly lower than that in the control group (38 [30.5-46] µg; P < .001). CONCLUSIONS Infiltration of ropivacaine and Diprospan can achieve satisfactory postoperative pain relief after craniotomy; it is a simple, easy, and safe technique, worth clinical promotion.
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Affiliation(s)
- Xueye Han
- From the Departments of Pain Management
| | - Tong Ren
- Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yang Wang
- From the Departments of Pain Management
| | - Nan Ji
- Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Fang Luo
- From the Departments of Pain Management
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17
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Proinflammatory profile in the skin of Parkinson's disease patients with and without pain. PLoS One 2022; 17:e0276564. [PMID: 36301901 PMCID: PMC9612575 DOI: 10.1371/journal.pone.0276564] [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: 08/12/2022] [Accepted: 10/08/2022] [Indexed: 11/05/2022] Open
Abstract
Background Pain is a common non-motor symptom of Parkinson`s disease (PD), however, its pathomechanism remains elusive. Objective We aimed to investigate the local gene expression of selected proinflammatory mediators in patients with PD and correlated our data with patients`pain phenotype. Methods We recruited 30 patients with PD and 30 healthy controls. Pain intensity of patients was assessed using the Numeric Rating Scale (NRS) and patients were stratified into PD pain (NRS≥4) and PD No Pain (NRS<4) subgroups. Skin punch biopsies were immunoassayed for protein-gene product 9.5 as a pan-neuronal marker and intraepidermal nerve fiber density (IEFND). Quantitative real-time polymerase chain reaction (qRT-PCR) analysis was performed to assess the gene expression of inflammatory mediators in the skin compared to controls. Results Patients with PD had lower distal IENFD compared to healthy controls. In skin samples, IL-2 (p<0.001) and TNF-α (p<0.01) were expressed higher in PD patients compared to controls. IL-1β (p<0.05) was expressed higher in the PD pain group compared to healthy controls. PD patients with pain receiving analgesics had a lower expression of TNF-α (p<0.05) in the skin compared to those not receiving treatment. Conclusions Our data suggest the occurrence of a local, peripheral inflammatory response in the skin in PD, but do not support this being a relevant factor contributing to pain in PD.
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Methylprednisolone as an Adjunct to Local Infiltration on Laminoplasty or Laminectomy before Wound Closure: A Randomized Controlled Trial. Pain Res Manag 2022; 2022:2274934. [PMID: 35966574 PMCID: PMC9366200 DOI: 10.1155/2022/2274934] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 05/15/2022] [Accepted: 06/07/2022] [Indexed: 11/17/2022]
Abstract
TrialDesign. Patients undergoing laminoplasty and laminectomy often experience severe postoperative pain. Local infiltration analgesia during spine surgery significantly reduces postoperative pain, which only upholds for a short time. Whether methylprednisolone and local anaesthetics are better than local anaesthetics alone in postoperative analgesia is yet to be determined. The primary aim of this research was the postoperative evaluation of efficacy and safety of methylprednisolone when used as an adjunct to local anaesthesia, ropivacaine, before wound closure after surgical procedures, laminoplasty or laminectomy. Methods. 132 patients were divided with a ratio of 1 : 1 into methylprednisolone-ropivacaine and ropivacaine alone groups. Every 30 ml of local infiltration solution consisted of 15 ml of 1% ropivacaine with 14 ml of saline along with 1 ml of 40 mg methylprednisolone and 15 ml of 1% ropivacaine with 15 ml of saline in methylprednisolone-ropivacaine group and ropivacaine group, respectively. The standardization of the study solution depended on the number of levels involved in surgery. Primary outcome was the 48-hour cumulative sufentanil demand. Results. Demographic characters and surgical variables among the groups were identical. The average 48-hour cumulative sufentanil demand was 32.5 ± 20.6 μg in the methylprednisolone-ropivacaine group and 50.9 ± 27.2 μg in the ropivacaine group (
). The estimated median time of demand of the first analgesia via patient-controlled analgesia (PCA) pump was 2.5 hours and 2 hours in the methylprednisolone-ropivacaine group and the ropivacaine group, respectively (hazard ratio (HR) was 0.53, with 95% Cl 0.33 to 0.87 and Log-rank of
). Conclusion. The infiltration of methylprednisolone as adjunct ropivacaine before wound closure is a safe and efficient strategy for pain management following laminoplasty or laminectomy.
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19
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Jaber K, McAuliffe M, Pedler A, Sterling M, O'Leary S. Further exploring the relationship between pressure pain thresholds and function in knee osteoarthritis. Musculoskelet Sci Pract 2022; 59:102542. [PMID: 35287029 DOI: 10.1016/j.msksp.2022.102542] [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: 08/16/2021] [Revised: 02/01/2022] [Accepted: 02/28/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Studies in Knee Osteoarthritis (KOA) have shown lowered Pressure Pain Threshold (PPT) values compared to healthy controls potentially signifying mechanical hypersensitivity, although the relevance of these findings to knee function remains unclear. OBJECTIVE This study further explores the relationship between PPT measures and knee function (self-reported, physical) in individuals undergoing total knee arthroplasty for advanced KOA. DESIGN Cross-sectional observational study. METHODS PPT's were recorded both local to the affected knee and at a remote site (deltoid) in 79 individuals with advanced KOA. Participants also completed self-report (Knee Society Score - functional sub-score) and physical (6-min walk test distance)) measures of knee function, as well as measures of pain-related psychological distress. Hierarchical linear regression models evaluated the relationship between the measures of function (self-report and physical measures modelled separately), PPT measures (local and remote), while accounting for demographic and psychological distress measures. RESULTS Higher knee PPT scores were independently associated with higher self-reported knee function (β 0.33, p < 0.02) and higher 6-min walk test distance (β 0.41, p < 0.01), although pain self-efficacy (β 0.33, p < 0.01) was also a significant variable in both models. Nearly identical findings were evident for PPT's measured at the deltoid. Overall PPT's could only explain a modest portion of variance (adjusted R2 = 0.15 to 0.17) in the functional measures. CONCLUSIONS PPT measures may be limited in their capacity to distinguish the impact of peripheral and central pain mechanisms on knee function in individuals undergoing total knee arthroplasty for advanced KOA.
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Affiliation(s)
- Khalid Jaber
- Ipswich General Hospital, Queensland Health, Ipswich, QLD, 4305, Australia; University of Queensland, School of Health and Rehabilitation Sciences, Brisbane, QLD, 4072, Australia.
| | - Michael McAuliffe
- Ipswich General Hospital, Queensland Health, Ipswich, QLD, 4305, Australia; The CJM Centre, Ipswich, QLD, 4305, Australia; The Mater Private Hospital, Springfield Lakes, QLD, 4300, Australia; St Andrew's Ipswich Private Hospital, Ipswich, QLD, 4305, Australia.
| | - Ashley Pedler
- RECOVER Injury Research Centre, NHMRC Centre of Research Excellence in Recovery After Road Traffic Injury, The University of Queensland, Australia.
| | - Michele Sterling
- RECOVER Injury Research Centre, NHMRC Centre of Research Excellence in Recovery After Road Traffic Injury, The University of Queensland, Australia.
| | - Shaun O'Leary
- University of Queensland, School of Health and Rehabilitation Sciences, Brisbane, QLD, 4072, Australia; Physiotherapy Department, Royal Brisbane and Women's Hospital, Herston, Brisbane, QLD, 4029, Australia.
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20
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Seidel MF, Hügle T, Morlion B, Koltzenburg M, Chapman V, MaassenVanDenBrink A, Lane NE, Perrot S, Zieglgänsberger W. Neurogenic inflammation as a novel treatment target for chronic pain syndromes. Exp Neurol 2022; 356:114108. [PMID: 35551902 DOI: 10.1016/j.expneurol.2022.114108] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 05/01/2022] [Accepted: 05/03/2022] [Indexed: 11/24/2022]
Abstract
Chronic pain syndrome is a heterogeneous group of diseases characterized by several pathological mechanisms. One in five adults in Europe may experience chronic pain. In addition to the individual burden, chronic pain has a significant societal impact because of work and school absences, loss of work, early retirement, and high social and healthcare costs. Several anti-inflammatory treatments are available for patients with inflammatory or autoimmune diseases to control their symptoms, including pain. However, patients with degenerative chronic pain conditions, some with 10-fold or more elevated incidence relative to these manageable diseases, have few long-term pharmacological treatment options, limited mainly to non-steroidal anti-inflammatory drugs or opioids. For this review, we performed multiple PubMed searches using keywords such as "pain," "neurogenic inflammation," "NGF," "substance P," "nociception," "BDNF," "inflammation," "CGRP," "osteoarthritis," and "migraine." Many treatments, most with limited scientific evidence of efficacy, are available for the management of chronic pain through a trial-and-error approach. Although basic science and pre-clinical pain research have elucidated many biomolecular mechanisms of pain and identified promising novel targets, little of this work has translated into better clinical management of these conditions. This state-of-the-art review summarizes concepts of chronic pain syndromes and describes potential novel treatment strategies.
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Affiliation(s)
- Matthias F Seidel
- Department of Rheumatology, Spitalzentrum Biel-Centre Hospitalier Bienne, 2501 Biel-Bienne, Switzerland.
| | - Thomas Hügle
- Department of Rheumatology, University Hospital Lausanne, 1011 Lausanne, Switzerland
| | - Barton Morlion
- The Leuven Center for Algology and Pain Management, University of Leuven, Leuven, Belgium
| | - Martin Koltzenburg
- Department of Clinical and Movement Neuroscience, UCL Queen Square Institute of Neurology, London, United Kingdom; Department of Clinical Neurophysiology, National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - Victoria Chapman
- Pain Centre Versus Arthritis, School of Life Sciences, Queen's Medical Centre, University of Nottingham, Nottingham, United Kingdom
| | - Antoinette MaassenVanDenBrink
- Division of Vascular Medicine and Pharmacology, Department of Internal Medicine, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Nancy E Lane
- Center for Musculoskeletal Health, University of California Davis School of Medicine, Sacramento, CA, USA; Department of Internal Medicine, University of California Davis School of Medicine, Sacramento, CA, USA
| | - Serge Perrot
- Unité INSERM U987, Hôpital Ambroise Paré, Paris Descartes University, Boulogne Billancourt, France; Centre d'Evaluation et Traitement de la Douleur, Hôpital Cochin, Paris Descartes University, Paris, France
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21
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Engel R, Barop H, Giebel J, Ludin SM, Fischer L. The Influence of Modern Neurophysiology on the Previous Definitions of "Segment" and "Interference Field" in Neural Therapy. Complement Med Res 2022; 29:257-267. [PMID: 35114664 DOI: 10.1159/000522391] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Accepted: 01/29/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND In neural therapy, local anesthetics are injected for diagnostic and therapeutic purposes. Up until now, a distinction has been made between "local/segmental neural therapy" and "interference field therapy". This division dating back to the middle of the last century was based on the assumption that anatomical and clinical segments were identical. However, this is only true for the projection symptoms, which are limited to metamerism. All pathophysiological processes beyond this segment were called "interference field events" ("outside of any segmental order" and "not explainable by neuroanatomical circuitry"). SUMMARY However, modern neurophysiology no longer recognizes segmental boundaries, taking into account the occurrence of cross-segmental sensitization processes, neuroplastic changes, immune processes, and neurogenic inflammation. In addition, new insights into neuroanatomical circuitry have also contributed to segmental expansion. Thus, the former definition of the interference field effect (considered to be outside any segmental order) is considered obsolete. Nowadays, interference fields are called "neuromodulatory triggers". They can act anywhere, both locally and fairly distant, and even systemically. Key Message: Thus, it is no longer tenable to classify interference field therapy as "unscientific" and "not recognized" while local and segmental neural therapy is being scientifically recognized.
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Affiliation(s)
- Raphaela Engel
- Formerly Neural Therapy, University of Bern, IKIM, Bern, Switzerland
| | - Hans Barop
- Practice for Neural Therapy, Hamburg, Germany
| | - Jürgen Giebel
- Institute for Anatomy and Cell Biology, University Medicine Greifswald, Greifswald, Germany
| | | | - Lorenz Fischer
- Formerly Neural Therapy, University of Bern, IKIM, Bern, Switzerland,
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22
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Mirabelli E, Elkabes S. Neuropathic Pain in Multiple Sclerosis and Its Animal Models: Focus on Mechanisms, Knowledge Gaps and Future Directions. Front Neurol 2022; 12:793745. [PMID: 34975739 PMCID: PMC8716468 DOI: 10.3389/fneur.2021.793745] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 11/17/2021] [Indexed: 12/22/2022] Open
Abstract
Multiple sclerosis (MS) is a multifaceted, complex and chronic neurological disease that leads to motor, sensory and cognitive deficits. MS symptoms are unpredictable and exceedingly variable. Pain is a frequent symptom of MS and manifests as nociceptive or neuropathic pain, even at early disease stages. Neuropathic pain is one of the most debilitating symptoms that reduces quality of life and interferes with daily activities, particularly because conventional pharmacotherapies do not adequately alleviate neuropathic pain. Despite advances, the mechanisms underlying neuropathic pain in MS remain elusive. The majority of the studies investigating the pathophysiology of MS-associated neuropathic pain have been performed in animal models that replicate some of the clinical and neuropathological features of MS. Experimental autoimmune encephalomyelitis (EAE) is one of the best-characterized and most commonly used animal models of MS. As in the case of individuals with MS, rodents affected by EAE manifest increased sensitivity to pain which can be assessed by well-established assays. Investigations on EAE provided valuable insights into the pathophysiology of neuropathic pain. Nevertheless, additional investigations are warranted to better understand the events that lead to the onset and maintenance of neuropathic pain in order to identify targets that can facilitate the development of more effective therapeutic interventions. The goal of the present review is to provide an overview of several mechanisms implicated in neuropathic pain in EAE by summarizing published reports. We discuss current knowledge gaps and future research directions, especially based on information obtained by use of other animal models of neuropathic pain such as nerve injury.
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Affiliation(s)
- Ersilia Mirabelli
- Reynolds Family Spine Laboratory, Department of Neurosurgery, New Jersey Medical School, Rutgers the State University of New Jersey, Newark, NJ, United States.,Department of Biology and Chemistry, School of Health Sciences, Liberty University, Lynchburg, VA, United States
| | - Stella Elkabes
- Reynolds Family Spine Laboratory, Department of Neurosurgery, New Jersey Medical School, Rutgers the State University of New Jersey, Newark, NJ, United States
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23
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Chiba D, Ohyama T, Sasaki E, Daimon M, Nakaji S, Ishibashi Y. Higher fasting blood glucose worsens knee symptoms in patients with radiographic knee osteoarthritis and comorbid central sensitization: an Iwaki cohort study. Arthritis Res Ther 2022; 24:269. [PMID: 36510322 PMCID: PMC9745982 DOI: 10.1186/s13075-022-02951-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Accepted: 11/04/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Although cross-sectional and cohort data suggest that higher serum blood glucose levels in patients with knee osteoarthritis (KOA) are associated with more severe knee symptoms, little is known about the longitudinal relationship between serum blood glucose and knee symptoms, particularly considering central sensitization (CS) comorbidity, which also worsens knee symptoms. METHODS We evaluated the longitudinal relationship between serum blood glucose and knee symptoms by dividing the cohort of patients with KOA into those with and without CS. We hypothesized that higher serum blood glucose levels would worsen knee symptoms. A total of 297 participants (mean age: 59.6 years; females: 211; average BMI: 23.7 kg/m2) were enrolled in this study. At baseline, plain radiographs of the bilateral knee joints were evaluated according to the Kellgren-Lawrence grade (KLG). All participants exhibited at least a KLG ≥ 2 in each knee. At baseline, fasting blood glucose (FBG) and Central Sensitization Inventory-9 (CSI-9) were evaluated; ≥ 10 points on the CSI-9 was defined as CS+. Knee injury and Osteoarthritis Outcome Score (KOOS) was evaluated at baseline and at 1-year follow-up; the change in KOOS (ΔKOOS) was calculated by subtracting the KOOS at baseline from that at the 1-year follow-up. Multiple linear regression analysis was conducted with ΔKOOS as the dependent variable and FBG at baseline as the independent variable, adjusted for age, sex, BMI, and CSI-9 at baseline. RESULTS Of the 297 subjects, 48 (16.2 %) were defined as CS+. In the CS - group, there was no association between FBG levels at baseline and ΔKOOS. In contrast, FBG at baseline was negatively associated with ΔKOOS pain (B = - 0.448; p = 0.003), ADL (B = - 0.438; p = 0.003), and sports (B = - 0.706; p = 0.007). CONCLUSIONS In patients with radiographic KOA and CS, higher blood glucose levels were associated with deteriorated knee symptoms during the 1-year follow-up. Healthcare providers should pay attention to controlling blood glucose, particularly in patients with KOA and concurrent CS, to mitigate their knee symptoms. STUDY DESIGN Retrospective cohort study (evidence level: III).
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Affiliation(s)
- Daisuke Chiba
- grid.257016.70000 0001 0673 6172Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562 Japan
| | - Tetsushi Ohyama
- grid.257016.70000 0001 0673 6172Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562 Japan
| | - Eiji Sasaki
- grid.257016.70000 0001 0673 6172Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562 Japan
| | - Makoto Daimon
- grid.257016.70000 0001 0673 6172Department of Endocrinology and Metabolism, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562 Japan
| | - Shigeyuki Nakaji
- grid.257016.70000 0001 0673 6172Department of Social Medicine, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562 Japan
| | - Yasuyuki Ishibashi
- grid.257016.70000 0001 0673 6172Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562 Japan
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24
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Fischer L, Barop H, Ludin SM, Schaible HG. Regulation of acute reflectory hyperinflammation in viral and other diseases by means of stellate ganglion block. A conceptual view with a focus on Covid-19. Auton Neurosci 2022; 237:102903. [PMID: 34894589 PMCID: PMC9761017 DOI: 10.1016/j.autneu.2021.102903] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 10/23/2021] [Accepted: 11/01/2021] [Indexed: 12/15/2022]
Abstract
Whereas the autonomic nervous system (ANS) and the immune system used to be assigned separate functions, it has now become clear that the ANS and the immune system (and thereby inflammatory cascades) work closely together. During an acute immune response (e. g., in viral infection like Covid-19) the ANS and the immune system establish a fast interaction resulting in "physiological" inflammation. Based on our knowledge of the modulation of inflammation by the ANS we propose that a reflectory malfunction of the ANS with hyperactivity of the sympathetic nervous system (SNS) may be involved in the generation of acute hyperinflammation. We believe that sympathetic hyperactivity triggers a hyperresponsiveness of the immune system ("cytokine storm") with consecutive tissue damage. These reflectory neuroimmunological and inflammatory cascades constitute a general reaction principle of the organism under the leadership of the ANS and does not only occur in viral infections, although Covid-19 is a typical current example therefore. Within the overreaction several interdependent pathological positive feedback loops can be detected in which the SNS plays an important part. Consequently, there is a chance to regulate the hyperinflammation by influencing the SNS. This can be achieved by a stellate ganglion block (SGB) with local anesthetics, temporarily disrupting the pathological positive feedback loops. Thereafter, the complex neuroimmune system has the chance to reorganize itself. Previous clinical and experimental data have confirmed a favorable outcome in hyperinflammation (including pneumonia) after SGB (measurable e. g. by a reduction in proinflammatory cytokines).
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Affiliation(s)
- Lorenz Fischer
- University of Bern, Interventional Pain Management, General Internal Medicine, Schwanengasse 5/7, 3011 Bern, Switzerland.
| | - Hans Barop
- Neural Therapy, Friedrich-Legahn-Str. 2, 22587 Hamburg, Germany
| | | | - Hans-Georg Schaible
- University Hospital Jena, Institute of Physiology1/Neurophysiology, Teichgraben 8, 07743 Jena, Germany.
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25
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Obese E, Biney RP, Henneh IT, Anokwah D, Adakudugu EA, Woode E, Ameyaw EO. Antinociceptive effect of the hydroethanolic leaf extract of Calotropis procera (Ait) R. Br. (Apocynaceae): Possible involvement of glutamatergic, cytokines, opioidergic and adenosinergic pathways. JOURNAL OF ETHNOPHARMACOLOGY 2021; 278:114261. [PMID: 34111540 DOI: 10.1016/j.jep.2021.114261] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 05/12/2021] [Accepted: 05/25/2021] [Indexed: 05/13/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Pain remains real and still a major problem in clinical medicine which requires new agents with improved efficacy for more therapeutic benefits. Plant sources can serve as a basis for the search for some novel drugs hence the analgesic effects of the hydroethanolic extract of Calotropis procera (CPE) which is widespread in Ghana and other tropical areas and used in folkloric medicine for painful and inflammatory conditions was evaluated. MATERIALS AND METHODS The analgesic properties of orally administered CPE at doses of 30, 100, and 300 mg/kg were evaluated in thermal (tail immersion), chemical (acetic acid-writhing, formalin-induced paw licking, glutamate-induced nociception) and mechanical (Randall-Selitto) tests for analgesia. The involvement of tumour necrosis factor-alpha (TNF-α), interleukin 1β (IL 1β), bradykinin, and prostaglandin E2 (PGE2) on the analgesic effects of CPE were also evaluated in hypernociception assays measuring mechanical pain thresholds. RESULTS The latency of tail withdrawal in the tail immersion test was significantly increased (p = 0.0001) while writhing induced by acetic acid was significantly reduced (p < 0.0001) on treatment with CPE (30-300 mg/kg). The extract also significantly inhibited both phase 1 and phase 2 nociceptive states induced by formalin comparable to morphine (p < 0.0001). Furthermore, the extract significantly attenuated hyper-nociception induced by TNF-α (p < 0.0001), interleukin 1β (p = 0.0102), bradykinin (p < 0.0001), and prostaglandin E2 (p < 0.0001). Additionally, glutamate-induced paw licking was reduced significantly (p < 0.05). The antinociceptive effects exhibited by CPE (100 mg/kg) in the formalin test was reversed by systemic administration of naloxone (2 mg/kg) and theophylline (5 mg/kg) but not glibenclamide (8 mg/kg), granisetron (2 mg/kg), atropine (3 mg/kg), yohimbine (3 mg/kg, p.o.) nor nifedipine (10 mg/kg). CONCLUSION Overall, the hydroethanolic leaf extract of Calotropis procera possesses analgesic properties that is mediated possibly through the glutaminergic, opioidergic, and adenosinergic pathways.
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Affiliation(s)
- Ernest Obese
- School of Pharmacy and Pharmaceutical Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Robert P Biney
- School of Pharmacy and Pharmaceutical Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Isaac T Henneh
- School of Pharmacy and Pharmaceutical Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Daniel Anokwah
- School of Pharmacy and Pharmaceutical Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Emmanuel A Adakudugu
- School of Pharmacy and Pharmaceutical Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Eric Woode
- Department of Pharmacology, School of Pharmacy, University of Health and Allied Sciences, Ho, Ghana
| | - Elvis O Ameyaw
- School of Pharmacy and Pharmaceutical Sciences, University of Cape Coast, Cape Coast, Ghana.
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26
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Fleckenstein J, Neuberger EWI, Bormuth P, Comes F, Schneider A, Banzer W, Fischer L, Simon P. Investigation of the Sympathetic Regulation in Delayed Onset Muscle Soreness: Results of an RCT. Front Physiol 2021; 12:697335. [PMID: 34603072 PMCID: PMC8481669 DOI: 10.3389/fphys.2021.697335] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 06/25/2021] [Indexed: 11/13/2022] Open
Abstract
Sports-related pain and injury is directly linked to tissue inflammation, thus involving the autonomic nervous system (ANS). In the present experimental study, we disable the sympathetic part of the ANS by applying a stellate ganglion block (SGB) in an experimental model of delayed onset muscle soreness (DOMS) of the biceps muscle. We included 45 healthy participants (female 11, male 34, age 24.16 ± 6.67 years [range 18-53], BMI 23.22 ± 2.09 kg/m2) who were equally randomized to receive either (i) an SGB prior to exercise-induced DOMS (preventive), (ii) sham intervention in addition to DOMS (control/sham), or (iii) SGB after the induction of DOMS (rehabilitative). The aim of the study was to determine whether and to what extent sympathetically maintained pain (SMP) is involved in DOMS processing. Focusing on the muscular area with the greatest eccentric load (biceps distal fifth), a significant time × group interaction on the pressure pain threshold was observed between preventive SGB and sham (p = 0.034). There was a significant effect on pain at motion (p = 0.048), with post hoc statistical difference at 48 h (preventive SGB Δ1.09 ± 0.82 cm VAS vs. sham Δ2.05 ± 1.51 cm VAS; p = 0.04). DOMS mediated an increase in venous cfDNA -as a potential molecular/inflammatory marker of DOMS- within the first 24 h after eccentric exercise (time effect p = 0.018), with a peak at 20 and 60 min. After 60 min, cfDNA levels were significantly decreased comparing preventive SGB to sham (unpaired t-test p = 0.008). At both times, 20 and 60 min, cfDNA significantly correlated with observed changes in PPT. The 20-min increase was more sensitive, as it tended toward significance at 48 h (r = 0.44; p = 0.1) and predicted the early decrease of PPT following preventive stellate blocks at 24 h (r = 0.53; p = 0.04). Our study reveals the broad impact of the ANS on DOMS and exercise-induced pain. For the first time, we have obtained insights into the sympathetic regulation of pain and inflammation following exercise overload. As this study is of a translational pilot character, further research is encouraged to confirm and specify our observations.
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Affiliation(s)
- Johannes Fleckenstein
- Department of Sports Medicine and Exercise Physiology, Institute of Sports Sciences, Goethe-Universität Frankfurt am Main, Frankfurt am Main, Germany
| | - Elmo W. I. Neuberger
- Department of Sports Medicine, Rehabilitation and Disease Prevention, Institute of Sports Sciences, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Philipp Bormuth
- Department of Sports Medicine and Exercise Physiology, Institute of Sports Sciences, Goethe-Universität Frankfurt am Main, Frankfurt am Main, Germany
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, Goethe-Universität Frankfurt am Main, Frankfurt am Main, Germany
| | - Fabio Comes
- Department of Sports Medicine and Exercise Physiology, Institute of Sports Sciences, Goethe-Universität Frankfurt am Main, Frankfurt am Main, Germany
- Department of Orthopedics, Orthopedic University Hospital Friedrichsheim gGmbH, Goethe-Universität Frankfurt am Main, Frankfurt am Main, Germany
| | - Angelika Schneider
- Department of Sports Medicine and Exercise Physiology, Institute of Sports Sciences, Goethe-Universität Frankfurt am Main, Frankfurt am Main, Germany
- Institute of Occupational, Social and Environmental Medicine, Goethe-Universität Frankfurt am Main, Frankfurt am Main, Germany
| | - Winfried Banzer
- Department of Sports Medicine and Exercise Physiology, Institute of Sports Sciences, Goethe-Universität Frankfurt am Main, Frankfurt am Main, Germany
- Institute of Occupational, Social and Environmental Medicine, Goethe-Universität Frankfurt am Main, Frankfurt am Main, Germany
| | - Lorenz Fischer
- Professor em. Interventional Pain Management, Neural Therapy, General Internal Medicine, University of Bern, Bern, Switzerland
| | - Perikles Simon
- Department of Sports Medicine, Rehabilitation and Disease Prevention, Institute of Sports Sciences, Johannes Gutenberg University Mainz, Mainz, Germany
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27
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Palsson TS, Doménech-García V, Boudreau SS, Graven-Nielsen T. Pain referral area is reduced by remote pain. Eur J Pain 2021; 25:1804-1814. [PMID: 33987881 DOI: 10.1002/ejp.1792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 05/02/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Endogenous pain inhibitory mechanisms are known to reduce pain intensity, but whether they influence the size and distribution of pain referral is unclear. This study aimed to determine if referred pain is reduced by applying a remote, conditioning painful stimulus. METHODS Twenty-four healthy men participated in this randomized, crossover study with a control and conditioning session. Referred pain was induced from the infraspinatus muscle (dominant side) by a painful pressure for 60 s. When applying pressure, the intensity was adjusted to a local pain intensity of 7/10 on a numerical rating scale. In the conditioning session, tonic painful pressure was simultaneously applied to the non-dominant leg during induction of referred pain. The area of referred pain was drawn onto a digital body chart and size extracted for data analysis. RESULTS For the total group and in a subgroup with distinct patterns of referred pain (n = 15/24), the pain area perceived in the back and front+back was smaller during the conditioning compared with the control (p < 0.05). No significant difference was found between sessions in a subgroup only demonstrating local pain (n = 9/24). CONCLUSIONS Engaging the descending noxious inhibitory control reduced the size of pain areas predominately when distinct pain referral was present. Assuming a conditioning effect of descending inhibitory control acting on dorsal horn neurons, these findings may indicate that mechanisms underlying pain referral can be modulated by endogenous control. The findings may indicate that referred pain may be a useful proxy to evaluate sensitivity of central pain mechanisms as previously suggested. SIGNIFICANCE The current results indicate a link between endogenous inhibition and pain referral. Descending inhibitory control effects on pain referral support a spinal mechanism involved in pain referral. Future studies should investigate whether the spatial characteristics of referred pain (e.g. size, frequency of affected body regions and distribution away from the primary nociceptive stimulus) can useful to evaluate the efficiency of endogenous pain modulation.
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Affiliation(s)
- Thorvaldur S Palsson
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Victor Doménech-García
- Department of Physiotherapy, Faculty of Health Sciences, Universidad San Jorge, Villanueva de Gállego, Zaragoza, Spain
| | - Shellie S Boudreau
- Center For Neuroplasticity and Pain (CNAP), Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Thomas Graven-Nielsen
- Center For Neuroplasticity and Pain (CNAP), Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
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Zhao C, Zhang N, Shrestha N, Liu H, Ge M, Luo F. Dexamethasone as a ropivacaine adjuvant to pre-emptive incision-site infiltration analgesia in pediatric craniotomy patients: A prospective, multicenter, randomized, double-blind, controlled trial. Paediatr Anaesth 2021; 31:665-675. [PMID: 33713371 DOI: 10.1111/pan.14178] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 02/13/2021] [Accepted: 03/03/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Dexamethasone added to incision-site infiltration has been routinely used to reduce pain after tonsillectomy in children. However, this has not been studied in pediatric craniotomy patients yet. We hypothesized that incision-site infiltration with a combination of ropivacaine and dexamethasone might provide superior analgesia to ropivacaine alone in pediatric craniotomy patients. METHODS In this multicenter, double-blind, randomized, controlled trial, children aged 2-12 years, scheduled for craniotomy, were prospectively enrolled at two study centers, from September 2, 2019, to July 5, 2020. Eighty children were randomly assigned (1:1) to either ropivacaine plus dexamethasone group who received pre-emptive incision-site infiltration with 0.2% ropivacaine plus 0.025% dexamethasone, or ropivacaine group who received 0.2% ropivacaine alone. Primary outcome was the modified Children's Hospital of Eastern Ontario Pain Scale (mCHEOPS) at 24 h postoperatively. Primary analysis was performed using the modified intention-to-treat principle. RESULTS Pre-emptive incision-site infiltration with ropivacaine plus dexamethasone had a reduced pain score of 2.0, compared with the pain score of 2.9 in the ropivacaine group, at 24 h postoperatively (mean difference -0.9, 95% confidence interval [CI], -1.7 to -0.2; p = .019). Estimated median of the time of first rescue analgesic demand was 24 h in the ropivacaine plus dexamethasone group and 8.5 h in the ropivacaine group [hazard ratio 0.43, 95% CI 0.24 to 0.08; Log-rank p = .0025]. No adverse events related to incision-site infiltration with dexamethasone were observed in this study. DISCUSSION Dexamethsone reduces the local production of pro-inflammatory factors after tissue damage and as a ropivacaine adjuvant for incision-site infiltration reduced the pain scores by 31% at 24 h postoperatively. The results were similar to several prior studies on to tonsillectomy patients. However, this changes on pain scores might has limited clinical significance. CONCLUSIONS The addition of dexamethasone to ropivacaine for preoperative incision-site infiltration has better postoperative analgesic effect than ropivacaine alone in pediatric craniotomy patients.
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Affiliation(s)
- Chunmei Zhao
- Department of Pain Management, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Nijia Zhang
- Department of Pediatric Neurosurgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Niti Shrestha
- Department of Pain Management, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Hongbing Liu
- Department of Pain Management, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Ming Ge
- Department of Pediatric Neurosurgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Fang Luo
- Department of Pain Management, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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29
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Mechanisms and Mediators of Pain in Chronic Inflammatory Arthritis. CURRENT TREATMENT OPTIONS IN RHEUMATOLOGY 2021. [DOI: 10.1007/s40674-021-00178-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Abstract
Purpose of the review
Pain in chronic inflammatory joint diseases is a common symptom reported by patients. Pain becomes of absolute clinical relevance especially when it becomes chronic, i.e., when it persists beyond normal healing times. As an operational definition, pain is defined chronic when it lasts for more than 3 months. This article aims to provide a review of the main mechanisms underlying pain in patients with chronic inflammatory joint diseases, discussing in particular their overlap.
Recent findings
While it may be intuitive how synovial inflammation or enthesitis are responsible for nociceptive pain, in clinical practice, it is common to find patients who continue to complain of symptoms despite optimal control of inflammation. In this kind of patients at the genesis of pain, there may be neuropathic or nociplastic mechanisms.
Summary
In the context of chronic inflammatory joint diseases, multiple mechanisms generally coexist behind chronic pain. It is the rheumatologist’s task to identify the mechanisms of pain that go beyond the nociceptive mechanisms, to adopt appropriate therapeutic strategies, including avoiding overtreatment of patients with immunosuppressive drugs. In this sense, future research will have to be oriented to search for biomarkers of non-inflammatory pain in patients with chronic inflammatory joint diseases.
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30
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Satake Y, Izumi M, Aso K, Igarashi Y, Sasaki N, Ikeuchi M. Comparison of Predisposing Factors Between Pain on Walking and Pain at Rest in Patients with Knee Osteoarthritis. J Pain Res 2021; 14:1113-1118. [PMID: 33907458 PMCID: PMC8068486 DOI: 10.2147/jpr.s298100] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 03/24/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose Patients with knee osteoarthritis (OA) complain of various types of pain, divided into two main categories: pain on movement and pain at rest. A thorough understanding of pain is essential for managing knee OA; however, few studies have investigated the mechanisms underlying the two different types of pain. This study aimed to clarify the predisposing factors for pain in patients with knee OA with a focus on differences between pain on walking and pain at rest. Patients and Methods This study involved 93 patients, aged 44–90 years, with knee OA, including 74 women. We assessed demographic variables (sex, age, body mass index [BMI], side), visual analogue scale (VAS) score on walking, VAS score at rest, Kellgren and Lawrence (KL) grade on radiograph, synovitis score and bone marrow lesion (BML) score on magnetic resonance imaging, and pressure pain threshold (PPT), and used univariate and multiple regression analyses to investigate factors predisposing patients to pain at rest or pain on walking. Results In the univariate analyses, we found significant correlations between VAS score on walking and BMI (r=0.31, p<0.01), KL grade (r=0.40, p<0.01), synovitis score (r=0.26, p=0.01), and BML score (r=0.36, p<0.01), whereas VAS score at rest correlated with PPT (r=−0.23, p=0.02) and BMI (r= 0.26, p=0.01). Multiple regression analysis showed that significant explanatory factors for VAS score on walking were BMI (β=0.22, p=0.03) and KL grade (β=0.27, p=0.03). By contrast, PPT was the only significant explanatory factor for VAS score at rest (β=−0.27, p=0.01). Conclusion Predisposing factors were significantly different between pain on walking and pain at rest, indicating that different pain mechanisms exist in the two types of pain. Pain on walking was more strongly associated with mechanical and structural factors, while pain at rest was associated with mechanical hyperalgesia of the knee. Clinical Registration University Hospital Medical Information Network Clinical Trials Registration number; 000041190.
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Affiliation(s)
- Yoshinori Satake
- Department of Orthopaedic Surgery, Kochi Medical School, Kochi University, Kochi, Japan
| | - Masashi Izumi
- Department of Orthopaedic Surgery, Kochi Medical School, Kochi University, Kochi, Japan
| | - Koji Aso
- Department of Orthopaedic Surgery, Kochi Medical School, Kochi University, Kochi, Japan
| | - Yoichi Igarashi
- Department of Orthopaedic Surgery, Tosa Municipal Hospital, Kochi, Japan
| | - Nao Sasaki
- Medicines Development Unit Japan, Eli Lilly Japan K.K., Hyogo, Japan
| | - Masahiko Ikeuchi
- Department of Orthopaedic Surgery, Kochi Medical School, Kochi University, Kochi, Japan
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Zhao C, Wang S, Pan Y, Ji N, Luo F. Pre-Emptive Incision-Site Infiltration with Ropivacaine Plus Dexamethasone for Postoperative Pain After Supratentorial Craniotomy: A Prospective Randomized Controlled Trial. J Pain Res 2021; 14:1071-1082. [PMID: 33907455 PMCID: PMC8064677 DOI: 10.2147/jpr.s300943] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 03/22/2021] [Indexed: 01/23/2023] Open
Abstract
Background Incision-site infiltration with local anesthetics prevents pain on incision site, but pain relief is limited to the first few postoperative hours. Dexamethasone as an adjuvant to local infiltration successfully achieves better postoperative pain relief; however, this has not been studied in craniotomy patients yet. Study Design and Methods This is a prospective, single-center, blinded, randomized, controlled trial included patients aged between 18 and 64 years, ASA physical status of I–II, scheduled for elective supratentorial tumor craniotomy under general anesthesia. We screened patients for enrollment from April 4, 2019 through August 15, 2019. The final study visit of the last patient was conducted on February 13, 2020. We randomly assigned eligible participants (1:1) to either the dexamethasone group who received incision-site infiltration of 0.5% ropivacaine plus 0.033% dexamethasone (N=70) or the control group who received 0.5% ropivacaine alone (N=70). Primary outcome was the cumulative sufentanil consumption (μg) within 48 hours postoperatively. Primary analysis was performed based on the modified intention-to-treat (MITT) principle. Results Baseline characteristics were similar between the groups (p>0.05). Sufentanil consumption during the first 48 hours postoperatively was 29.0 (10.7) μg in the dexamethasone group and 38.3 (13.7) μg in the control group (mean difference −9.3, 95% CI −13.4 to −5.1; p<0.001). There was no serious adverse effect directly associated with incision-site infiltration or local dexamethasone use. Conclusion The addition of dexamethasone to pre-emptive incision-site infiltration with the local anesthetic can reduce about 27% of opioids consumption and the postoperative pain scores within 72 hours after craniotomy. Trial Registration ClinicalTrials.Gov (NCT03618264).
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Affiliation(s)
- Chunmei Zhao
- Department of Pain Management, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, People's Republic of China
| | - Shaoheng Wang
- Department of Pain Management, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, People's Republic of China
| | - Yuesong Pan
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, People's Republic of China.,China National Clinical Research Center for Neurological Diseases, Beijing, 100070, People's Republic of China
| | - Nan Ji
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, People's Republic of China
| | - Fang Luo
- Department of Pain Management, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, People's Republic of China
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32
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Hegarty DA, Bretherton B. An Open-Label Pilot Study Investigating Noninvasive High-Frequency Peripheral Nerve Fiber Stimulation in Chronic Pain. Pain Pract 2020; 21:578-587. [PMID: 33369130 DOI: 10.1111/papr.12993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 12/15/2020] [Accepted: 12/17/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Providing sustained and effective treatment via the peripheral nervous system for the management of chronic pain is challenging. Application of noninvasive high-frequency stimulation at or near the painful area may benefit those with chronic pain. This open-label pilot survey examined the impact of this stimulation on pain intensity, activities of daily living, functional capacity, and medication consumption after 2 weeks of treatment. METHODS Stimulation was administered at home using the summation of two high-frequency sinusoidal alternating signals at 3858 and 3980 Hz delivered between two electrodes placed directly over one or two locations of pain. Individuals completed a survey after 2 weeks to assess pain, activities of daily living (ADL), pain medication consumption, quality of life (QoL), mood, sleep, functional outcomes, and satisfaction. RESULTS 463 individuals (372 males; 91 females) retuned the completed survey after 2 weeks of treatment. Pain and ADL scores significantly improved at follow-up compared with baseline (pain mean difference: 3.05; 95% confidence interval [CI]: 2.86, 3.24; ADL mean difference: 1.82; 95% CI: 1.60, 2.04). Corresponding improvements in QoL, sleep, mood, functional outcomes, and satisfaction were noted. On average, 8.00 ± 11.11 hours of pain relief were reported with 54% experiencing reductions in pain medication consumption. 98% would use the stimulation in the future. CONCLUSION Two weeks of noninvasive high-frequency peripheral nerve fiber stimulation appeared to confer positive effects in individuals with chronic pain. Future research employing a control group/arm is needed to establish the long-term impact of this bioelectric technique in specific pain cohorts.
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Affiliation(s)
- Dominic A Hegarty
- Pain Management and Neuromodulation, Mater Private Hospital, Cork, Ireland.,Department of Anesthesiology, School of Medicine, University College, Cork, Ireland
| | - Beatrice Bretherton
- School of Biomedical Sciences, Faculty of Biological Sciences, University of Leeds, Leeds, UK.,Pain Management Department, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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33
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Simon LS, Taylor PC, Choy EH, Sebba A, Quebe A, Knopp KL, Porreca F. The Jak/STAT pathway: A focus on pain in rheumatoid arthritis. Semin Arthritis Rheum 2020; 51:278-284. [PMID: 33412435 DOI: 10.1016/j.semarthrit.2020.10.008] [Citation(s) in RCA: 97] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 09/02/2020] [Accepted: 10/23/2020] [Indexed: 12/16/2022]
Abstract
Pain is a manifestation of rheumatoid arthritis (RA) that is mediated by inflammatory and non-inflammatory mechanisms and negatively affects quality of life. Recent findings from a Phase 3 clinical trial showed that patients with RA who were treated with a Janus kinase 1 (Jak1) and Janus kinase 2 (Jak2) inhibitor achieved significantly greater improvements in pain than those treated with a tumor necrosis factor blocker; both treatments resulted in similar changes in standard clinical measures and markers of inflammation. These findings suggest that Jak1 and Jak2 inhibition may relieve pain in RA caused by inflammatory and non-inflammatory mechanisms and are consistent with the overarching involvement of the Jak-signal transducer and activator of transcription (Jak/STAT) pathway in mediating the action, expression, and regulation of a multitude of pro- and anti-inflammatory cytokines. In this review, we provide an overview of pain in RA, the underlying importance of cytokines regulated directly or indirectly by the Jak/STAT pathway, and therapeutic targeting of the Jak/STAT pathway in RA. As highlighted herein, multiple cytokines directly or indirectly regulated by the Jak/STAT pathway play important roles in mediating various mechanisms underlying pain in RA. Having a better understanding of these mechanisms may help clinicians make treatment decisions that optimize the control of inflammation and pain.
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Affiliation(s)
| | - Peter C Taylor
- Botnar Research Centre, University of Oxford, Oxford, UK
| | - Ernest H Choy
- CREATE Centre, Division of Infection and Immunity, Cardiff University School of Medicine, Cardiff, UK
| | | | | | | | - Frank Porreca
- Department of Pharmacology, College of Medicine, University of Arizona, 1501 N. Campbell Avenue, Tucson, AZ 85718, USA.
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34
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Wang M, Thyagarajan B. Pain pathways and potential new targets for pain relief. Biotechnol Appl Biochem 2020; 69:110-123. [PMID: 33316085 DOI: 10.1002/bab.2086] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 12/06/2020] [Indexed: 12/15/2022]
Abstract
Pain is an unpleasant sensory and emotional experience that affects a sizable percentage of people on a daily basis. Sensory neurons known as nociceptors built specifically to detect damaging stimuli can be found throughout the body. They transmit information about noxious stimuli from mechanical, thermal, and chemical sources to the central nervous system and higher brain centers via electrical signals. Nociceptors express various channels and receptors such as voltage-gated sodium and calcium channels, transient receptor potential channels, and opioid receptors that allow them to respond in a highly specific manner to noxious stimuli. Attenuating the pain response can be achieved by inhibiting or altering the expression of these pain targets. Achieving a deeper understanding of how these receptors can be affected at the molecular level can lead to the development of novel pain therapies. This review will discuss the mechanisms of pain, introduce the various receptors that are responsible for detecting pain, and future directions in pharmacological therapies.
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Affiliation(s)
- Menglan Wang
- Department of Pharmaceutical Sciences, School of Pharmacy, University of Wyoming, Laramie, WY, USA
| | - Baskaran Thyagarajan
- Department of Pharmaceutical Sciences, School of Pharmacy, University of Wyoming, Laramie, WY, USA
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35
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Tissue Levels of Flurbiprofen in the Rat Plantar Heel after Short-Duration Topical Iontophoresis Are Sufficient to Induce Pharmacodynamic Responses to Local Pain Stimuli. Pharmaceutics 2020; 12:pharmaceutics12070608. [PMID: 32629832 PMCID: PMC7408369 DOI: 10.3390/pharmaceutics12070608] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 06/27/2020] [Accepted: 06/28/2020] [Indexed: 11/16/2022] Open
Abstract
The objective of this study was to investigate the topical iontophoresis of flurbiprofen (FBF) as a means to enhance its local bioavailability and thereby provide an improved and targeted treatment of plantar heel pain. Initial in vitro experiments using porcine ear skin investigated iontophoretic transport of FBF under different conditions. Local FBF biodistribution in the rat paw in vivo was compared after topical or oral administration. Efficacy of pain management was investigated using a plantar incisional model by evaluating pharmacodynamic responses to local pain stimuli. The results demonstrated that iontophoresis of FBF significantly increased cutaneous deposition and transdermal permeation of FBF as compared to passive delivery—it also enabled drug input to be controlled by modulation of current density and drug concentration (r2 > 0.99). Topical iontophoresis of FBF in vivo enabled higher drug levels in skin and muscle in rat plantar aspect and superior pharmacodynamic responses to local pain stimuli, in comparison to oral and passive delivery. In conclusion, short-duration topical iontophoresis of FBF may better help to relieve plantar heel pain than oral or passive administration, which should be of clinical interest.
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36
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Abd-Elsayed A, Jackson M, Gu SL, Fiala K, Gu J. Neuropathic pain and Kv7 voltage-gated potassium channels: The potential role of Kv7 activators in the treatment of neuropathic pain. Mol Pain 2020; 15:1744806919864256. [PMID: 31342847 PMCID: PMC6659175 DOI: 10.1177/1744806919864256] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Neuropathic pain conditions severely and chronically affect the quality of life
in a large human population, but the pain conditions are not adequately managed
due to poor understanding of their underlying mechanisms. There is a pressing
need for further research into this field to help develop effective and
nonaddictive medications to treat neuropathic pain. This article first describes
general clinical classification of pain, types and symptoms of neuropathic pain,
and current practices of clinical management for neuropathic pain. This is
followed by a discussion of various cellular and molecular mechanisms
responsible for the development and maintenance of neuropathic pain. In this
review, we highlight the loss of function of Kv7 voltage-gated potassium as a
mechanism of neuropathic pain and the potential use of Kv7 channel activator as
subsequent treatment.
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Affiliation(s)
- Alaa Abd-Elsayed
- 1 Department of Anesthesiology, University of Cincinnati, Cincinnati, OH, USA.,2 Department of Anesthesiology, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Markus Jackson
- 1 Department of Anesthesiology, University of Cincinnati, Cincinnati, OH, USA
| | - Steven L Gu
- 3 Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kenneth Fiala
- 2 Department of Anesthesiology, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Jianguo Gu
- 1 Department of Anesthesiology, University of Cincinnati, Cincinnati, OH, USA.,3 Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
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37
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Bumgarner JR, Walker WH, Liu JA, Walton JC, Nelson RJ. Dim Light at Night Exposure Induces Cold Hyperalgesia and Mechanical Allodynia in Male Mice. Neuroscience 2020; 434:111-119. [PMID: 32201267 PMCID: PMC7176554 DOI: 10.1016/j.neuroscience.2020.03.022] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 03/10/2020] [Accepted: 03/12/2020] [Indexed: 01/13/2023]
Abstract
The growing presence of artificial lighting across the globe presents a number of challenges to human and ecological health despite its societal benefits. Exposure to artificial light at night, a seemingly innocuous aspect of modern life, disrupts behavior and physiological functions. Specifically, light at night induces neuroinflammation, which is implicated in neuropathic and nociceptive pain states, including hyperalgesia and allodynia. Because of its influence on neuroinflammation, we investigated the effects of dim light at night exposure on pain responsiveness in male mice. In this study, mice exposed to four days of dim (5 lux) light at night exhibited cold hyperalgesia. Further, after 28 days of exposure, mice exhibited both cold hyperalgesia and mechanical allodynia. No heat/hot hyperalgesia was observed in this experiment. Altered nociception in mice exposed to dim light at night was concurrent with upregulated interleukin-6 and nerve growth factor mRNA expression in the medulla and elevated μ-opioid receptor mRNA expression in the periaqueductal gray region of the brain. The current results support the relationship between disrupted circadian rhythms and altered pain sensitivity. In summary, we observed that dim light at night induces cold hyperalgesia and mechanical allodynia, potentially through elevated neuroinflammation and dysregulation of the endogenous opioid system.
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Affiliation(s)
- Jacob R Bumgarner
- Department of Neuroscience, Rockefeller Neuroscience Institute, West Virginia University, Morgantown, WV 26506, USA.
| | - William H Walker
- Department of Neuroscience, Rockefeller Neuroscience Institute, West Virginia University, Morgantown, WV 26506, USA
| | - Jennifer A Liu
- Department of Neuroscience, Rockefeller Neuroscience Institute, West Virginia University, Morgantown, WV 26506, USA
| | - James C Walton
- Department of Neuroscience, Rockefeller Neuroscience Institute, West Virginia University, Morgantown, WV 26506, USA
| | - Randy J Nelson
- Department of Neuroscience, Rockefeller Neuroscience Institute, West Virginia University, Morgantown, WV 26506, USA
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38
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Lecchi C, Zamarian V, Gini C, Avanzini C, Polloni A, Rota Nodari S, Ceciliani F. Salivary microRNAs are potential biomarkers for the accurate and precise identification of inflammatory response after tail docking and castration in piglets. J Anim Sci 2020; 98:skaa153. [PMID: 32374403 PMCID: PMC7245537 DOI: 10.1093/jas/skaa153] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 04/30/2020] [Indexed: 02/07/2023] Open
Abstract
The present study aimed to investigate whether acute pain associated with castration and tail docking of male piglets may modulate the expression of salivary microRNAs (miRNAs) and to explore their potential use as biomarkers. Thirty-six healthy 4-d-old piglets (Hermitage × Duroc) were randomly assigned to three groups: the first group (12 piglets) has been pretreated with anesthetic and anti-inflammatory drugs (ANA) and then castrated and tail docked; the second one (12 piglets) has been castrated and tail docked without any drugs (CONV); the third one (12 piglets) has been only handled (SHAM). Saliva was collected 10 min before (control group) and 30 to 45 min after the procedures. Salivary cortisol has been quantified. The expression concentrations of seven miRNAs, namely miR-19b, miR-27b-3p, miR-215, miR-22-3p, miR-155-5p, hsa-miR-365-5p, and hsa-miR-204, were measured and assessed as potential biomarkers of pain by quantitative Polimerase Chain Reaction using TaqMan probes. The area under the receiver operating curve (AUC) was used to evaluate the diagnostic performance of miRNAs. The concentration of salivary cortisol increased after treatment in CONV and ANA, while no significant variation was observed in the SHAM group. The comparative analysis demonstrated that the concentrations of salivary miR-19b (P = 0.001), miR-27b (P = 0.042), and miR-365 (P < 0.0001) were significantly greater in CONV as compared with pretreatment. The AUC of pretreatment vs. CONV and CONV vs. ANA were excellent for miR-19b and miR-365 and fair for miR-27b. Combining two miRNAs, namely miR-19b and miR-365, in a panel increased the efficiency of distinguishing between pre- and post-treatment groups. No differences have been identified between SHAM and ANA groups. mRNA potential targets of differentially expressed-miRNA were investigated, and genes related to pain and inflammation were identified: miR-19b potentially modulates TGF-beta and focal adhesion pathways, miR-365 regulates cytokines expression (i.e., IL-1, Tumor Necross Factor-alpha, and IL-8 cytokine), and miR-27b regulates macrophage inflammatory protein pathways (i.e., MIP1-beta). In conclusion, we demonstrated that the abundance of miR-19b, miR-27b, and miR-365 increases in the saliva of piglets castrated and tail docked without the administration of pain-relieving drugs. Further studies are needed to assess their potential during routine husbandry procedures and to extend their assessment in other stressful events, such as weaning or chronic pain.
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Affiliation(s)
- Cristina Lecchi
- Dipartimento di Medicina Veterinaria, Università degli Studi di Milano, Milano, Italy
| | - Valentina Zamarian
- Dipartimento di Medicina Veterinaria, Università degli Studi di Milano, Milano, Italy
| | - Chiara Gini
- Dipartimento di Medicina Veterinaria, Università degli Studi di Milano, Milano, Italy
| | | | - Alessia Polloni
- Istituto Zooprofilattico Sperimentale della Lombardia e dell’Emilia Romagna, Brescia, Italy
| | - Sara Rota Nodari
- Istituto Zooprofilattico Sperimentale della Lombardia e dell’Emilia Romagna, Brescia, Italy
| | - Fabrizio Ceciliani
- Dipartimento di Medicina Veterinaria, Università degli Studi di Milano, Milano, Italy
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Kim HL, Lee HJ, Lee DR, Choi BK, Yang SH. Anti-osteoarthritic Effects of an Herbal Composition LI73014F2 on Interleukin-1β-induced Primary Human Articular Chondrocytes. Molecules 2020; 25:molecules25092033. [PMID: 32349389 PMCID: PMC7249004 DOI: 10.3390/molecules25092033] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 04/16/2020] [Accepted: 04/25/2020] [Indexed: 01/10/2023] Open
Abstract
Osteoarthritis (OA) is one of the most well-characterized joint diseases and is associated with chondrocyte inflammation, metalloproteinase upregulation and apoptosis. LI73014F2 is a novel composition prepared from aqueous extract of Terminalia chebula fruit, alcohol extract of Curcuma longa rhizome, and Boswellia serrata extract at 2:1:2 ratio. Earlier studies have shown that LI73014F2 inhibits cyclooxygenase-2 (COX-2), 5-lipoxygenase (5-LOX) activities, and attenuates clinical symptoms in OA subjects. In the present study, we evaluated the protective anti-inflammatory and anti-apoptotic effects, as well as the underlying mechanisms, of LI73014F2 in interleukin (IL)-1β-induced inflammation in human primary chondrocytes. Human chondrocytes were treated with LI73014F2 (0, 12.5, 25 and 50 μg/mL) in IL-1β (10 ng/mL)-containing chondrocyte growth medium for 24 h. Cell viability was assessed using an MTT assay. The pro-inflammatory mediator, inflammatory cytokines, MMPs, apoptosis-related proteins, mitogen-activated protein kinase (MAPK) and nuclear factor-κB (NF-κB) signaling pathways protein expression levels were detected by western blot analysis. The results demonstrated that LI73014F2 normalized the expressions of COX-2, mPGES-1, PGE2, 5-LOX, LTB4, IL-1β, TNFα, IL-6, MMP-2, MMP-3, MMP-9, MMP-13, Bax/Bcl-2, cleaved caspase-9 and -3, cleaved PARP, phospho-NF-κB p65 and phospho-p38 MAPK proteins in IL-1β-induced primary human chondrocytes. Moreover, the data suggested that LI73014F2 reduced IL-1β-induced inflammation and apoptosis, at least partially via the inhibition of the NF-κB/MAPK signaling pathway. In conclusion, the present findings provide the molecular basis of the anti-OA efficacy of LI73014F2.
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Affiliation(s)
- Hae Lim Kim
- Department of Biotechnology, Chonnam National University, Yeosu 59626, Korea; (H.L.K.); (H.J.L.)
| | - Hae Jin Lee
- Department of Biotechnology, Chonnam National University, Yeosu 59626, Korea; (H.L.K.); (H.J.L.)
| | - Dong-Ryung Lee
- Nutrapharm Tech, Jungwon-gu, Seongnam, Gyunggi 13201, Korea; (D.-R.L.); (B.-K.C.)
| | - Bong-Keun Choi
- Nutrapharm Tech, Jungwon-gu, Seongnam, Gyunggi 13201, Korea; (D.-R.L.); (B.-K.C.)
| | - Seung Hwan Yang
- Department of Biotechnology, Chonnam National University, Yeosu 59626, Korea; (H.L.K.); (H.J.L.)
- Correspondence: ; Tel.: +82-61-659-7306
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40
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Korte SM, Straub RH. Fatigue in inflammatory rheumatic disorders: pathophysiological mechanisms. Rheumatology (Oxford) 2020; 58:v35-v50. [PMID: 31682277 PMCID: PMC6827268 DOI: 10.1093/rheumatology/kez413] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 08/09/2019] [Indexed: 12/13/2022] Open
Abstract
Today, inflammatory rheumatic disorders are effectively treated, but many patients still suffer from residual fatigue. This work presents pathophysiological mechanisms of fatigue. First, cytokines can interfere with neurotransmitter release at the preterminal ending. Second, a long-term increase in serum concentrations of proinflammatory cytokines increase the uptake and breakdown of monoamines (serotonin, noradrenaline and dopamine). Third, chronic inflammation can also decrease monoaminergic neurotransmission via oxidative stress (oxidation of tetrahydrobiopterin [BH4]). Fourth, proinflammatory cytokines increase the level of enzyme indoleamine-2, 3-dioxygenase activity and shunt tryptophan away from the serotonin pathway. Fifth, oxidative stress stimulates astrocytes to inhibit excitatory amino acid transporters. Sixth, astrocytes produce kynurenic acid that acts as an antagonist on the α7-nicotinic acetylcholine receptor to inhibit dopamine release. Jointly, these actions result in increased glutamatergic and decreased monoaminergic neurotransmission. The above-described pathophysiological mechanisms negatively affect brain functioning in areas that are involved in fatigue.
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Affiliation(s)
- S Mechiel Korte
- Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences, (UIPS), Utrecht University, Utrecht, The Netherlands.,Department of Biopsychology, Faculty of Psychology, Ruhr-Universität, Bochum
| | - Rainer H Straub
- Laboratory of Experimental Rheumatology and Neuroendocrine Immunology, Department of Internal Medicine, University Hospital, Regensburg, Germany
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41
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Ebbinghaus M, Müller S, Segond von Banchet G, Eitner A, Wank I, Hess A, Hilger I, Kamradt T, Schaible HG. Contribution of Inflammation and Bone Destruction to Pain in Arthritis: A Study in Murine Glucose-6-Phosphate Isomerase-Induced Arthritis. Arthritis Rheumatol 2019; 71:2016-2026. [PMID: 31332965 DOI: 10.1002/art.41051] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 07/16/2019] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Arthritis is often characterized by inflammation and bone destruction. This study was undertaken to investigate the contribution of inflammation and bone destruction to pain. METHODS Inflammation, bone resorption, pain-related behaviors, and molecular markers (activating transcription factor 3 [ATF-3], p-CREB, and transient receptor potential vanilloid channel 1) in sensory neurons were measured in murine glucose-6-phosphate isomerase (G6PI)-induced arthritis, a model of rheumatoid arthritis. Depletion of Treg cells before immunization changed self-limiting arthritis into nonremitting arthritis with pronounced bone destruction. Zoledronic acid (ZA) was administered to reduce bone resorption. RESULTS Compared to nondepleted mice, Treg cell-depleted mice exhibited arthritis with more severe bone destruction and higher guarding scores (P < 0.05; n = 10 mice per group) as well as more persistent thermal hyperalgesia (P < 0.05), but displayed similar mechanical hyperalgesia at the hindpaws (n = 18-26 mice per group). These pain-related behaviors, as well as an up-regulation of the neuronal injury marker ATF-3 in sensory neurons (studied in 39 mice), appeared before the clinical score (inflammation) became positive and persisted in Treg cell-depleted and nondepleted mice. In the late stage of arthritis, Treg cell-depleted mice treated with ZA showed less bone resorption (<50%; P < 0.01) and less thermal hyperalgesia (P < 0.01) than Treg cell-depleted mice without ZA treatment (n = 15 mice per group), but ZA treatment did not reduce the clinical score and local mechanical hyperalgesia. CONCLUSION Pain-related behaviors precede and outlast self-limiting arthritis. In nonremitting arthritis with enhanced bone destruction, mainly local thermal, but not local mechanical, hyperalgesia was aggravated. The up-regulation of ATF-3 indicates an early and persisting affection of sensory neurons by G6PI-induced arthritis.
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Affiliation(s)
- Matthias Ebbinghaus
- Jenna University Hospital, Friedrich Schiller University Jena, Jena, Germany
| | - Sylvia Müller
- Jenna University Hospital, Friedrich Schiller University Jena, Jena, Germany
| | | | - Annett Eitner
- Jenna University Hospital, Friedrich Schiller University Jena, Jena, Germany
| | - Isabel Wank
- Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Andreas Hess
- Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Ingrid Hilger
- Jenna University Hospital, Friedrich Schiller University Jena, Jena, Germany
| | - Thomas Kamradt
- Jenna University Hospital, Friedrich Schiller University Jena, Jena, Germany
| | - Hans-Georg Schaible
- Jenna University Hospital, Friedrich Schiller University Jena, Jena, Germany
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Goto T, Nakagami G, Minematsu T, Tomida S, Shinoda M, Iwata K, Sanada H. Topically injected adrenocorticotropic hormone induces mechanical hypersensitivity on a full‐thickness cutaneous wound model in rats. Exp Dermatol 2019; 28:1010-1016. [DOI: 10.1111/exd.13994] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 05/01/2019] [Accepted: 06/19/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Taichi Goto
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine The University of Tokyo Bunkyo‐ku Tokyo Japan
- Global Leadership Initiative for an Age‐Friendly Society The University of Tokyo Bunkyo‐ku Tokyo Japan
| | - Gojiro Nakagami
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine The University of Tokyo Bunkyo‐ku Tokyo Japan
- Division of Care Innovation, Global Nursing Research Center, Graduate School of Medicine The University of Tokyo Bunkyo‐ku Tokyo Japan
| | - Takeo Minematsu
- Division of Care Innovation, Global Nursing Research Center, Graduate School of Medicine The University of Tokyo Bunkyo‐ku Tokyo Japan
- Department of Skincare Science, Graduate School of Medicine The University of Tokyo, Bunkyo‐ku Tokyo Japan
| | - Sanai Tomida
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine The University of Tokyo Bunkyo‐ku Tokyo Japan
| | - Masamichi Shinoda
- Department of Physiology Nihon University School of Dentistry Chiyoda‐ku Tokyo Japan
| | - Koichi Iwata
- Department of Physiology Nihon University School of Dentistry Chiyoda‐ku Tokyo Japan
| | - Hiromi Sanada
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine The University of Tokyo Bunkyo‐ku Tokyo Japan
- Division of Care Innovation, Global Nursing Research Center, Graduate School of Medicine The University of Tokyo Bunkyo‐ku Tokyo Japan
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Jiang Y, Greenwood-Van Meerveld B, Johnson AC, Travagli RA. Role of estrogen and stress on the brain-gut axis. Am J Physiol Gastrointest Liver Physiol 2019; 317:G203-G209. [PMID: 31241977 PMCID: PMC6734369 DOI: 10.1152/ajpgi.00144.2019] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 06/19/2019] [Accepted: 06/19/2019] [Indexed: 01/31/2023]
Abstract
Symptoms of functional gastrointestinal disorders (FGIDs), including fullness, bloating, abdominal pain, and altered gastrointestinal (GI) motility, present a significant clinical problem, with a reported prevalence of 25%-40% within the general population. More than 60% of those affected seek and require healthcare, and affected individuals report a significantly decreased quality of life. FGIDs are highly correlated with episodes of acute and chronic stress and are increased in prevalence and reported severity in women compared with men. Although there is evidence that sex and stress interact to exacerbate FGID symptoms, the physiological mechanisms that mediate these sex-dependent disparities are incompletely understood, although hormonal-related differences in GI motility and visceral sensitivity have been purported to play a significant role in the etiology. In this mini review, we will discuss brain-gut axis control of GI motility and sensitivity, the influence of estrogen on GI motility and sensitivity, and stress modulation of the brain-gut axis.
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Affiliation(s)
- Yanyan Jiang
- Department of Neural and Behavioral Sciences, Penn State College of Medicine, Hershey, Pennsylvania
| | - Beverley Greenwood-Van Meerveld
- Oklahoma Center for Neuroscience, University of Oklahoma Health Science Center, Oklahoma City, Oklahoma
- Veterans Affairs Health Care System, Oklahoma City, Oklahoma
| | - Anthony C Johnson
- Veterans Affairs Health Care System, Oklahoma City, Oklahoma
- Department of Neurology, University of Oklahoma Health Science Center, Oklahoma City, Oklahoma
| | - R Alberto Travagli
- Department of Neural and Behavioral Sciences, Penn State College of Medicine, Hershey, Pennsylvania
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Nausch B, Pace S, Pein H, Koeberle A, Rossi A, Künstle G, Werz O. The standardized herbal combination BNO 2103 contained in Canephron ® N alleviates inflammatory pain in experimental cystitis and prostatitis. PHYTOMEDICINE : INTERNATIONAL JOURNAL OF PHYTOTHERAPY AND PHYTOPHARMACOLOGY 2019; 60:152987. [PMID: 31257118 DOI: 10.1016/j.phymed.2019.152987] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 06/03/2019] [Accepted: 06/08/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND Urinary tract infections are among the most common types of infections and give rise to inflammation with pain as one of the main symptoms. The herbal medicinal product Canephron® N contains BNO 2103, a defined mixture of pulverized rosemary leaves, centaury herb, and lovage root, and has been used in the treatment of urinary tract infections for more than 25 years. PURPOSE To test the hypothesis that BNO 2103 reduces pain in cystitis and prostatitis by virtue of anti-inflammatory properties, and to reveal potential mechanisms underlying the anti-inflammatory features. STUDY DESIGN BNO 2103 was studied for anti-inflammatory and analgesic properties in three animal models in vivo, and the mode of action underlying the anti-inflammatory features was investigated in human leukocytes and cell-free assays in vitro. METHODS To assess the anti-inflammatory and analgesic efficacy of BNO 2103 we employed cyclophosphamide-induced cystitis and carrageenan-induced prostatitis in rats, and zymosan-induced peritonitis in mice. Human neutrophils and monocytes as well as isolated human 5-lipoxygenase and microsomal prostaglandin E2 synthase-1-containing microsomes were utilized to assess inhibition of leukotriene and/or prostaglandin E2 production by HPLC and/or ELISA. RESULTS When given orally, BNO 2103 reduced inflammation and hyperalgesia in experimental cystitis in rats, while individual components of BNO 2103 also reduced hyperalgesia. Furthermore, BNO 2103 reduced hyperalgesia in rats with carrageenan-induced prostatitis. Cell-based and cell-free studies implicate inhibition of prostaglandin E2 and leukotriene B4 biosynthesis as potential mechanisms underlying the analgesic and anti-inflammatory effects. CONCLUSION Our data support the hypothesis that BNO 2103 reduces pain by virtue of its anti-inflammatory properties, possibly related to suppression of prostaglandin E2 and leukotriene B4 formation, and suggest that this combination has the potential to treat clinical symptoms such as inflammatory pain. Thus BNO 2103 may represent an alternative to reduce the use of antibiotics in urinary tract infections.
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Affiliation(s)
- Bernhard Nausch
- Bionorica SE, Kerschensteinerstrasse 11-15, 92318 Neumarkt, Germany.
| | - Simona Pace
- Department of Pharmaceutical/Medicinal Chemistry, Institute of Pharmacy, Friedrich-Schiller-University Jena, Philosophenweg 14, 07743 Jena, Germany
| | - Helmut Pein
- Department of Pharmaceutical/Medicinal Chemistry, Institute of Pharmacy, Friedrich-Schiller-University Jena, Philosophenweg 14, 07743 Jena, Germany
| | - Andreas Koeberle
- Department of Pharmaceutical/Medicinal Chemistry, Institute of Pharmacy, Friedrich-Schiller-University Jena, Philosophenweg 14, 07743 Jena, Germany
| | - Antonietta Rossi
- Department of Pharmacy, School of Medicine, University of Naples Federico II, Via D. Montesano 49, I-80131 Naples, Italy
| | - Gerald Künstle
- Bionorica SE, Kerschensteinerstrasse 11-15, 92318 Neumarkt, Germany
| | - Oliver Werz
- Department of Pharmaceutical/Medicinal Chemistry, Institute of Pharmacy, Friedrich-Schiller-University Jena, Philosophenweg 14, 07743 Jena, Germany.
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Morgan PT, Bailey SJ, Banks RA, Fulford J, Vanhatalo A, Jones AM. Contralateral fatigue during severe-intensity single-leg exercise: influence of acute acetaminophen ingestion. Am J Physiol Regul Integr Comp Physiol 2019; 317:R346-R354. [PMID: 31141387 PMCID: PMC6732432 DOI: 10.1152/ajpregu.00084.2019] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Exhaustive single-leg exercise has been suggested to reduce time to task failure (Tlim) during subsequent exercise in the contralateral leg by exacerbating central fatigue development. We investigated the influence of acetaminophen (ACT), an analgesic that may blunt central fatigue development, on Tlim during single-leg exercise completed with and without prior fatiguing exercise of the contralateral leg. Fourteen recreationally active men performed single-leg severe-intensity knee-extensor exercise to Tlim on the left (Leg1) and right (Leg2) legs without prior contralateral fatigue and on Leg2 immediately following Leg1 (Leg2-CONTRA). The tests were completed following ingestion of 1-g ACT or maltodextrin [placebo (PL)] capsules. Intramuscular phosphorus-containing metabolites and substrates and muscle activation were assessed using 31P-MRS and electromyography, respectively. Tlim was not different between Leg1ACT and Leg1PL conditions (402 ± 101 vs. 390 ± 106 s, P = 0.11). There was also no difference in Tlim between Leg2ACT-CONTRA and Leg2PL-CONTRA (324 ± 85 vs. 311 ± 92 s, P = 0.10), but Tlim was shorter in Leg2ACT-CONTRA and Leg2PL-CONTRA than in Leg2CON (385 ± 104 s, both P < 0.05). There were no differences in intramuscular phosphorus-containing metabolites and substrates or muscle activation between Leg1ACT and Leg1PL and between Leg2ACT-CONTRA and Leg2PL-CONTRA (all P > 0.05). These findings suggest that levels of metabolic perturbation and muscle activation at Tlim are not different during single-leg severe-intensity knee-extensor exercise completed with or without prior fatiguing exercise of the contralateral leg. Despite contralateral fatigue, ACT ingestion did not alter neuromuscular responses, muscle metabolites, or exercise performance.
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Affiliation(s)
- Paul T Morgan
- Department of Sport and Health Sciences, College of Life and Environmental Sciences, University of Exeter, St. Luke's Campus, Exeter, United Kingdom
| | - Stephen J Bailey
- Department of Sport and Health Sciences, College of Life and Environmental Sciences, University of Exeter, St. Luke's Campus, Exeter, United Kingdom
| | - Rhys A Banks
- Department of Sport and Health Sciences, College of Life and Environmental Sciences, University of Exeter, St. Luke's Campus, Exeter, United Kingdom
| | - Jonathan Fulford
- Peninsula Clinical Research Facility, National Institute for Health Research, College of Medicine and Health, Exeter, United Kingdom
| | - Anni Vanhatalo
- Department of Sport and Health Sciences, College of Life and Environmental Sciences, University of Exeter, St. Luke's Campus, Exeter, United Kingdom
| | - Andrew M Jones
- Department of Sport and Health Sciences, College of Life and Environmental Sciences, University of Exeter, St. Luke's Campus, Exeter, United Kingdom
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Razmjou H, Woodhouse LJ, Holtby R. Neuropathic Pain after Shoulder Arthroplasty: Prevalence, Impact on Physical and Mental Function, and Demographic Determinants. Physiother Can 2018; 70:212-220. [PMID: 30275646 DOI: 10.3138/ptc.2016-99] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Purpose: The objectives of this survey study were to provide an estimate of the prevalence of neuropathic pain (NP) and to explore the cross-sectional and longitudinal group differences postoperatively. Method: A cohort of consecutive patients who had undergone total shoulder arthroplasty (TSA), reverse shoulder arthroplasty (RSA), or humeral head replacement (HHR) were surveyed within an average of 3.8 years after surgery. Questionnaires completed at the time of the survey were the Self-Administered Leeds Assessment of Neuropathic Symptoms and Signs (S-LANSS) pain scale, the visual analogue scale (VAS) for pain, the Western Ontario Osteoarthritis of the Shoulder (WOOS) index, the Patient Health Questionnaire-9 (PHQ-9), and a satisfaction questionnaire. Results: Of the 141 candidates who were invited to participate in the study, 115 patients participated (85 TSA, 21 HHR, and 9 RSA), for an 82% response rate. Five patients (4%) met the criteria for NP, of whom one had a loosening of the prosthesis and required further surgery. Having NP was associated with greater pain (VAS; p=0.001), greater depression (PHQ-9; p=0.001), more disability (WOOS; p=0.030), and less satisfaction with the surgery (p=0.014). There was no relationship between the presence of NP and patients' age, sex, preoperative pain, range of motion results, or WOOS scores (p>0.05). Conclusions: Persistent pain of neuropathic origin is not common after shoulder arthroplasty, but it is a significant contributor to poor mental and physical well-being and thus warrants further research.
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Affiliation(s)
- Helen Razmjou
- Department of Rehabilitation, Holland Orthopaedic & Arthritic Centre.,Department of Physical Therapy.,Sunnybrook Research Institute
| | - Linda J Woodhouse
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton.,McCaig Institute for Bone and Joint Health, Calgary
| | - Richard Holtby
- Division of Orthopaedic Surgery, Department of Surgery, Sunnybrook Health Sciences Centre.,Division of Orthopaedic Surgery, Department of Surgery, Faculty of Medicine, University of Toronto, Toronto
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Validation of an index of Sensitivity to Movement-Evoked Pain in patients with whiplash injuries. Pain Rep 2018; 3:e661. [PMID: 30123856 PMCID: PMC6085141 DOI: 10.1097/pr9.0000000000000661] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 04/17/2018] [Accepted: 04/18/2018] [Indexed: 11/25/2022] Open
Abstract
Introduction: Sensitivity to Movement-Evoked Pain is a pain summation phenomenon identified in various chronic pain populations. Objectives: This study investigated the validity of a procedure used to assess pain summation in response to a repeated lifting task in individuals with whiplash injuries. Methods: Sixty-five participants completed measures of pain severity and duration, Temporal Summation (TS) of pinprick pain, pain catastrophizing and fear of movement, and work-related disability before lifting a series of 18 weighted canisters. An index of Sensitivity to Movement-Evoked Pain was computed as the increase in pain reported by participants over successive lifts of the weighted canisters. An index of TS was computed by dividing the pain reported in response to the final pinprick by the pain reported in response to the 1st pinprick in a train of 10 pinpricks. Results: Analyses replicated previous findings showing a repetitive lifting task-induced pain summation in approximately 20% to 25% of a sample of individuals with whiplash injuries. Analyses also revealed significant correlations between SMEP, TS, and pain-related psychological variables. Hierarchical regression analyses showed that TS and pain catastrophizing made significant unique contributions to the prediction of SMEP. These findings join a growing body of research on movement-evoked pain in persistent spinal pain conditions. Conclusion: The repeated lifting task used in this study successfully induced pain summation in a group of patients with whiplash injuries.
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Jaber K, O'Leary S, Pedler A, Sterling M, McAuliffe M. Evidence of generalised mechanical hyperalgesia in patients with advanced knee osteoarthritis undergoing total knee arthroplasty. Knee 2018; 25:459-465. [PMID: 29685500 DOI: 10.1016/j.knee.2018.03.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 11/11/2017] [Accepted: 03/01/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND AND OBJECTIVE Persistent pain is reported in up to 34% of patients following total knee arthroplasty (TKA) for management of knee osteoarthritis (KOA). Persistent pain in this group is thought to be at least partly reflective of pain sensory hypersensitivity. The objective of this study was to evaluate sensory hypersensitivity, using mechanical and thermal quantitative sensory testing, in patients about to undergo TKA. DESIGN AND METHODS Pressure pain thresholds (PPT) and cold pain thresholds (CPT) were recorded from 30 participants prior to their TKA, and compared with recordings taken from 30 healthy control participants of similar age and gender. Thresholds were recorded locally and remotely (other knee, deltoid) to the operative knee. Group comparisons (KOA, control, groups) were made using a general linear mixed models approach with age, gender, and body mass index (BMI) included as covariates. Pairwise comparisons were conducted with Bonferonni correction for multiple comparisons. RESULTS Significantly lower PPTs were at all measured sites in the KOA group compared to the control group (P<0.001 at all sites, except the deltoid P=0.004). Males demonstrated higher pain threshold compared to females, averaged over all sites, P=0.02. There were no observed between-group differences in CPT (P=0.122). CONCLUSIONS This study suggested that some individuals about to undergo TKA for their advanced KOA demonstrated widespread mechanical sensory hypersensitivity. These findings have potentially important clinical implications regarding perioperative and longer-term pain management in these patients.
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Affiliation(s)
- Khalid Jaber
- Ipswich General Hospital, Queensland Health, Ipswich, Australia; School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia.
| | - Shaun O'Leary
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia; Physiotherapy Department, Royal Brisbane and Women's Hospital, Herston, Brisbane, Australia
| | - Ashley Pedler
- RECOVER Injury Research Centre, NHMRC Centre of Research Excellence in Recovery After Road Traffic Injury, Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
| | - Michele Sterling
- RECOVER Injury Research Centre, NHMRC Centre of Research Excellence in Recovery After Road Traffic Injury, Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
| | - Michael McAuliffe
- Ipswich General Hospital, Queensland Health, Ipswich, Australia; The CJM Centre, Ipswich, Australia; The Mater Private Hospital, Springfield Lakes, Australia; St Andrew's Ipswich Private Hospital, Ipswich, Australia
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50
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Keszthelyi D, Aziz Q, Ruffle JK, O'Daly O, Sanders D, Krause K, Williams SCR, Howard MA. Delineation between different components of chronic pain using dimension reduction - an ASL fMRI study in hand osteoarthritis. Eur J Pain 2018. [PMID: 29520913 PMCID: PMC6055802 DOI: 10.1002/ejp.1212] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Background Traditional psychometric measures aimed at characterizing the pain experience often show considerable overlap, due to interlinked affective and modulatory processes under central nervous system control. Neuroimaging studies have been employed to investigate this complexity of pain processing, in an attempt to provide a quantifiable, adjunctive description of pain perception. In this exploratory study, we examine psychometric and neuroimaging data from 38 patients with painful osteoarthritis of the carpometacarpal joint. We had two aims: first, to utilize principal component analysis (PCA) as a dimension reduction strategy across multiple self‐reported endpoints of pain, cognitive and affective functioning; second, to investigate the relationship between identified dimensions and regional cerebral blood flow (rCBF) as an indirect measure of brain activity underpinning their ongoing pain experiences. Methods Psychometric data were collected using validated questionnaires. Quantitative estimates of rCBF were acquired using pseudo‐continuous arterial spin‐labelled functional magnetic resonance imaging. Results Two principal components were identified that accounted for 73% of data variance; one related to pain scores and a second to psychological traits. Voxel‐wise multiple regression analysis revealed a significant negative association between the ‘pain score’ component and rCBF to a right temporal lobe cluster, including the amygdala and the parahippocampal cortex. Conclusion We suggest this association may represent a coping mechanism that aims to reduce fear‐related pain‐anxiety. Further investigation of central brain processing mechanisms in osteoarthritis‐related pain may offer insights into more effective therapeutic strategies. Significance This study demonstrates that dimension reduction using PCA allows insight into pain perception and its affective components in relation to brain activation patterns in patients with painful hand osteoarthritis.
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Affiliation(s)
- D Keszthelyi
- Division of Gastroenterology, Department of Internal Medicine, Maastricht University Medical Center, Maastricht, the Netherlands.,Centre for Neuroscience and Trauma, Blizard Institute, Wingate Institute of Neurogastroenterology, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, UK.,Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience at King's College London, UK
| | - Q Aziz
- Centre for Neuroscience and Trauma, Blizard Institute, Wingate Institute of Neurogastroenterology, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, UK
| | - J K Ruffle
- Centre for Neuroscience and Trauma, Blizard Institute, Wingate Institute of Neurogastroenterology, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, UK.,Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience at King's College London, UK
| | - O O'Daly
- Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience at King's College London, UK
| | - D Sanders
- Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience at King's College London, UK.,Pain Management Research Institute, The University of Sydney at Royal North Shore Hospital, St Leonards, NSW, Australia
| | - K Krause
- Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience at King's College London, UK.,Department of Neurology, Philipps-University Marburg, Marburg, Germany
| | - S C R Williams
- Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience at King's College London, UK
| | - M A Howard
- Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience at King's College London, UK
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