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Kim JH. Complications and safety of cervical interlaminar epidural block. Korean J Pain 2024; 37:185-187. [PMID: 38946694 PMCID: PMC11220378 DOI: 10.3344/kjp.24186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2024] [Revised: 06/22/2024] [Accepted: 06/23/2024] [Indexed: 07/02/2024] Open
Affiliation(s)
- Jae Hun Kim
- Department of Anesthesiology and Pain Medicine, Konkuk University School of Medicine, Seoul, Korea
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Kim SY, Jang JN, Choi YS, Park S, Yi J, Song Y, Kim JW, Kang KN, Kim YU. The cervical ligamentum flavum area: A new sensitive morphological parameter for identifying the cervical spinal stenosis. Medicine (Baltimore) 2023; 102:e36259. [PMID: 38013374 PMCID: PMC10681602 DOI: 10.1097/md.0000000000036259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 11/01/2023] [Indexed: 11/29/2023] Open
Abstract
Thickening of the cervical ligamentum flavum (CLF) has been considered as a main cause of cervical spinal stenosis (CSS). A previous study reported that cervical ligamentum flavum thickness (CLFT) is correlated with CSS. However, the whole hypertrophy is different from focal thickness. Therefore, to analyze hypertrophy of the CLF, we created a new morphological parameter, called the cervical ligamentum flavum area (CLFA). We hypothesized that the CLFA is an important morphological parameter in the diagnosis of CSS. CLF samples were acquired from 83 patients with CSS, and from 84 controls who underwent cervical magnetic resonance imaging (C-MRI). T2-weighted axial C-MRI images were acquired. We measured the CLFA and CLFT at the C6-C7 intervertebral level on C-MRI using appropriate image analysis software. The CLFA was measured as the cross-sectional area of the entire CLF at the level of C6-C7 stenosis. The CLFT was measured by drawing a straight line along the ligament side towards the spinal canal at the C6-C7 level. Mean CLFA was 25.24 ± 6.43 mm2 in the control group and 45.34 ± 9.09 mm2 in the CSS group. The average CLFT was 1.48 ± 0.28 mm in the control group and 2.09 ± 0.35 mm in the CSS group. CSS patients had significantly higher CLFA (P < .01) and CLFT (P < .01). For the validity of both CLFA and CLFT as predictors of CSS, a receiver operating characteristic curve analysis revealed an optimal cutoff point for the CLFA was 31.66 mm2, a sensitivity of 92.8%, specificity of 88.4%, and an area under the curve of 0.97 (95% CI, 0.94-0.99). The optimal cut off-point of the CLFT was 1.79 mm, with a sensitivity of 83.5%, specificity of 84.5%, and an area under the curve of 0.92 (95% CI, 0.87-0.96). Both CLFT and CLFA were significantly related to CSS, but CLFA was the more sensitive measurement parameter. Therefore, to evaluate patients with CSS, treating physicians should test for CLFA.
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Affiliation(s)
- So Yeon Kim
- Department of Neurosurgery, Catholic Kwandong University of Korea College of Medicine, International St. Mary’s Hospital, Incheon, Republic of Korea
| | - Jae Ni Jang
- Department of Anesthesiology and Pain Medicine, Catholic Kwandong University of Korea College of Medicine, International St. Mary’s Hospital, Incheon, Republic of Korea
| | - Young-Soon Choi
- Department of Anesthesiology and Pain Medicine, Catholic Kwandong University of Korea College of Medicine, International St. Mary’s Hospital, Incheon, Republic of Korea
| | - Sukhee Park
- Department of Anesthesiology and Pain Medicine, Catholic Kwandong University of Korea College of Medicine, International St. Mary’s Hospital, Incheon, Republic of Korea
| | - Jungmin Yi
- Department of Anesthesiology and Pain Medicine, Catholic Kwandong University of Korea College of Medicine, International St. Mary’s Hospital, Incheon, Republic of Korea
| | - Yumin Song
- Department of Anesthesiology and Pain Medicine, Catholic Kwandong University of Korea College of Medicine, International St. Mary’s Hospital, Incheon, Republic of Korea
| | - Jae Won Kim
- Catholic Kwandong University of Korea College of Medicine, Gangneung, Republic of Korea
| | - Keum Nae Kang
- Department of Anesthesiology and Pain Medicine, National Police Hospital, Seoul, Republic of Korea
| | - Young Uk Kim
- Department of Anesthesiology and Pain Medicine, Catholic Kwandong University of Korea College of Medicine, International St. Mary’s Hospital, Incheon, Republic of Korea
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Cankurtaran D, Aykın Yığman Z, Güzel Ş, Umay E. The importance of myofascial trigger points in chronic neck pain: An ultrasonography preliminary study. PM R 2023; 15:954-964. [PMID: 36989071 DOI: 10.1002/pmrj.12974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 03/04/2023] [Accepted: 03/14/2023] [Indexed: 03/30/2023]
Abstract
BACKGROUND Ultrasonographic evaluation of trigger points detected by physical examination in patients with myofascial pain syndrome is being used more frequently in clinical care. However, the sonographic appearance of trigger points, in association with pain and disability, has not been adequately described. OBJECTIVE To reveal the presence of trigger points with ultrasonography in those with myofascial pain syndrome and to determine if ultrasound images can help discriminate between demographic and disease characteristics. METHODS Fifty-two participants with chronic neck pain (NP) were in this cross-sectional study. The pain intensity was evaluated using a 0-10 cm visual analog scale (VAS). The neck disability index measured the NP-induced disability status of the participants. Ultrasonography was used to measure the thicknesses of the paraspinal muscles and the presence of hypoechoic areas within these muscles. RESULTS There was a positive correlation between the VAS scores of the participants and the ultrasonographic detection of myofascial trigger points (MTPs) in the multifidus and middle trapezius muscles (right/left r = .30, p = .027; r = .29, p = .029; r = .32, p = .009, r = .30, p = .011, respectively). These features correlated with the disability levels of the participants and the MTPs on both the right and left sides of the splenius, multifidus, upper trapezius, and middle trapezius (r = .32, p = .028; r = .38, p = .013, r = .25, p = .027; r = .33, p = .016; r = .25, p = .025, r = .32, p = .018, r = .28, p = .013, r = .29, p = .016, respectively). A significant correlation was present between the detection of MTP at ultrasonography and decreased muscle thickness in the relevant muscles (between p = .001 and p = .034). CONCLUSION The detection of MTPs with ultrasonography is associated with the severity of pain and disability in those with chronic NP. Features on ultrasound include hypoechoic changes within muscle and reduced muscle thickness associated with MTPs.
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Affiliation(s)
- Damla Cankurtaran
- Department of Physical Medicine and Rehabilitation, University of Health Sciences Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Zeynep Aykın Yığman
- Department of Physical Medicine and Rehabilitation, Ankara Mamak State Hospital, Ankara, Turkey
| | - Şükran Güzel
- Department of Physical Medicine and Rehabilitation, University of Health Sciences Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Ebru Umay
- Department of Physical Medicine and Rehabilitation, University of Health Sciences Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
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Lee JH, Lee JH, Chang MC. Transforaminal Epidural Steroid Injection for Patients with Lumbosacral Disc Herniation in the Absence of Spine Magnetic Resonance Imaging - Is Better Really the Enemy of the Best? J Pain Res 2023; 16:1477-1485. [PMID: 37168846 PMCID: PMC10166140 DOI: 10.2147/jpr.s402405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 05/02/2023] [Indexed: 05/13/2023] Open
Abstract
Purpose This study aimed to evaluate the effect of transforaminal epidural steroid injection (TFESI) in patients with lumbosacral disc herniation by comparing its effect between those diagnosed by clinical evaluation and plain radiography only (X-ray group) and those by additional magnetic resonance imaging (MRI) (MRI group). Additionally, we investigated the accuracy of the preliminary clinical assumption in the X-ray group using confirmative post-injection MRI. Patients and Methods We retrospectively recruited 367 patients with back and radicular pain due to lumbosacral disc herniation from a single pain clinic. Among them, 201 and 166 patients were categorized into the X-ray and MRI groups, respectively. In the X-ray group, the pathological level assumed initially by clinical evaluation and plain radiography concurred with that confirmed later on post-injection MRI in 139 patients (corresponding group); the remaining 62 patients lacked this concurrence (non-corresponding group). The NRS scores and Macnab criteria results were compared between the X-ray and MRI groups as well as the corresponding and non-corresponding groups. Results Both the X-ray and MRI groups showed significant reductions in the NRS scores at 2 and 10 weeks post-injection when compared with the pretreatment scores. However, no significant difference was noted between the groups in terms of the magnitude of clinical improvement assessed by successful reduction in the NRS or Macnab scores. Furthermore, similar results were obtained in the comparison between the corresponding and non-corresponding groups of the X-ray group. Conclusion TFESI guarantees favorable clinical outcomes even in the absence of confirmative MRI in patients with back and radicular pain. The preemptive application of this procedure could be prioritized and justified in patients suspected of lumbosacral disc herniation based on clinical evaluation and plain radiography only without the preceding MRI verification.
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Affiliation(s)
- Jung Hwan Lee
- Namdarun Rehabilitation Clinic, Yongin-City, Gyeonggi-Do, South Korea
| | - Jun Ho Lee
- Department of Neurosurgery, Kyung Hee University Medical Center, Seoul, 02447, South Korea
| | - Min Cheol Chang
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Daegu, 705-717, Republic of Korea
- Correspondence: Min Cheol Chang, Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, 317-1, Daemyungdong, Namku, Daegu, 705-717, Republic of Korea, Tel +82-53-620-4862, Email
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Choi J, Park HB, Lim T, Yi SW, Lee S, Park S, Park S, Yi J, Kim YU. Best cutoff score of cervical-pedicle thickness as a morphological parameter for predicting cervical central stenosis. Medicine (Baltimore) 2022; 101:e30014. [PMID: 35984177 PMCID: PMC9388033 DOI: 10.1097/md.0000000000030014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
There are various factors for the cause of cervical central stenosis (CCS), such as osteophyte, cervical-disc degeneration, and cervical ligamentum flavum hypertrophy. However, the pedicle of the cervical vertebra has not yet been analyzed for its relationship with CCS. We created a new morphologic parameter called the cervical-pedicle thickness (CPT) to assess the association between CCS and the cervical pedicle. We obtained morphological cases involving the CPT from 82 patients with CCS. There were also 84 in the normal group who underwent cervical spine magnetic resonance imaging (CS-MR) as part of routine health screening. We obtained the T2-weighted CS-MR axial images from group members, and assessed the CPT at the level of the C6 vertebra on CS-MR. The mean CPT was 3.46 ± 0.57 mm in the normal group, 4.97 ± 0.75 mm in the CCS group, which thus had a significantly higher CPT (P < .01) than did the normal group. For the prognostic value of the CPT as a predictor of CCS, ROC analysis indicated that the best cutoff score for the CPT was 4.18 mm, with 93.9% sensitivity, 92.9% specificity, and AUC 0.97. Greater CPT was highly associated with a possibility of CCS. This conclusion will be helpful for assessing the CCS patients.
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Affiliation(s)
- Jungho Choi
- Department of Internal Medicine, Catholic Kwandong University of Korea College of Medicine, International St. Mary’s Hospital, Incheon, Korea
| | - Hyung-Bok Park
- Department of Internal Medicine, Catholic Kwandong University of Korea College of Medicine, International St. Mary’s Hospital, Incheon, Korea
| | - Taeha Lim
- Department of Anesthesiology and Pain Medicine, Eulji General Hospital, Eulji University College of Medicine, Seoul, Korea
| | - Shin Wook Yi
- Department of Anesthesiology and Pain Medicine, Eulji General Hospital, Eulji University College of Medicine, Seoul, Korea
| | - Sooho Lee
- Department of Anesthesiology and Pain Medicine, Catholic Kwandong University of Korea College of Medicine, International St. Mary’s Hospital, Incheon, Korea
| | - Sukhee Park
- Department of Anesthesiology and Pain Medicine, Catholic Kwandong University of Korea College of Medicine, International St. Mary’s Hospital, Incheon, Korea
| | - SoYoon Park
- Department of Anesthesiology and Pain Medicine, Catholic Kwandong University of Korea College of Medicine, International St. Mary’s Hospital, Incheon, Korea
| | - Jungmin Yi
- Department of Anesthesiology and Pain Medicine, Catholic Kwandong University of Korea College of Medicine, International St. Mary’s Hospital, Incheon, Korea
| | - Young Uk Kim
- Department of Anesthesiology and Pain Medicine, Catholic Kwandong University of Korea College of Medicine, International St. Mary’s Hospital, Incheon, Korea
- Department of Radiological Sciences, University of California, Irvine, CA
- *Correspondence: Young Uk Kim, MD, PhD, Department of Anesthesiology and Pain Medicine, Catholic Kwandong University of Korea College of Medicine, International ST. Mary’s Hospital, Incheon, Republic of Korea (e-mail: )
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Clinical Efficacy of Epidural Injections of Local Anesthetic Alone or Combined with Steroid for Neck Pain: A Systematic Review and Meta-Analysis. BIOMED RESEARCH INTERNATIONAL 2022; 2022:8952220. [PMID: 35663039 PMCID: PMC9162875 DOI: 10.1155/2022/8952220] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 05/09/2022] [Indexed: 11/17/2022]
Abstract
Aims To compare the effectiveness of cervical epidural injections of local anesthetic with vs. without a steroid. Methods Three databases (PubMed, Embase, and Cochrane library) were used to search and assess all clinical randomized controlled trials regarding the clinical efficacy of epidural injections from January 01, 2009, to October 31, 2020. Cochrane review criteria and the Interventional Pain Management Techniques-Quality Appraisal of Reliability and Risk of Bias Assessment instrument were used to evaluate the methodologic quality of the included studies. Qualitative and quantitative analyses were performed according to best evidence synthesis principles and by single-arm meta-analysis, respectively. Results Based on the search criteria, 4 RCTs were qualitatively and quantitatively analyzed in the single-arm meta-analysis. Treatment with lidocaine alone or with the steroid resulted in decreases of 4.46 and 4.29 points, respectively, in pain scores and of 15.8 and 14.46 points, respectively, in functional scores at 6 months. Similar trends were observed at the 1-year follow-up: pain scores decreased by 4.27 and 4.14 points, while functional scores decreased by 15.94 and 14.44 points in patients with neck pain who received lidocaine without or with the steroid, respectively. In the 3 studies that reported 2-year follow-up data, patients with neck pain treated with lidocaine or lidocaine + steroid showed 4.2- and 4.14-point decreases, in pain score and 15.92- and 14.89-point decreases, respectively, in functional scores. Conclusions The studies showed level I (strong) evidence for short- and long-term improvements in pain relief and functionality with cervical epidural injections of local anesthetic alone or with a steroid in the management of neck pain.
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Rubio-Haro R, De Andrés-Serrano C, Noriega González DC, Bordes-García C, DE Andrés J. Adjacent segment syndrome after failed back surgery: biomechanics, diagnosis, and treatment. Minerva Anestesiol 2021; 88:282-292. [PMID: 34709016 DOI: 10.23736/s0375-9393.21.15939-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The adjacent segment syndrome is defined as the changes in the adjacent structures of an operated spinal level that produce symptoms of pain and disability, which worsen the quality of life of a patient. Pain management specialists must be aware of these biomechanical changes brought by spinal surgeries, as well as of the symptoms associated with pain after surgery, to reach an appropriate diagnosis and provide an adequate treatment. Specialized pain literature contains few reports on specific management of patients using the terms "adjacent segment syndrome, degeneration or disease"; most of the literature comes from surgical journals. It is necessary to perform studies with a population sample comprising patients with adjacent segment syndrome after spinal surgery, since almost all treatments applied in this group are extrapolated from those used in patients with pain originating in the same area but who have not previously undergon spine surgery. Therefore, we consider necessary for pain physicians to understand the underlying biomechanics, promote the diagnosis of this condition, and analyze possible treatments in patients with adjacent segment disease to alleviate their pain and improve their quality of life.
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Affiliation(s)
- Ruben Rubio-Haro
- Anesthesia, Critical Care and Pain Management Department, Valencia University General Hospital, Valencia, Spain -
| | - Carmen De Andrés-Serrano
- Multidisciplinary Pain Clinic, Vithas Virgen del Consuelo Hospital, Carrer de Callosa d'En Sarrià, Valencia, Spain
| | - David C Noriega González
- Column Unit Section, Orthopedic Surgery Service, University Clinic Hospital of Valladolid, Valladolid, Spain
| | - Clara Bordes-García
- Anesthesia Critical Care and Pain Management Department, Vall d'Hebron Hospital, Barcelona, Spain
| | - Jose DE Andrés
- Anesthesia Critical Care and Pain Management Department, Valencia University General Hospital, Valencia University Medical School, Valencia, Spain
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Jeong HW, Yi J, Lee S, Park S, Kang KN, Lee J, Cho HR, Kim YU. Prognostic value of cervical ligamentum flavum thickness as a morphological parameter to predict cervical stenosis. Medicine (Baltimore) 2021; 100:e27084. [PMID: 34449510 PMCID: PMC8389973 DOI: 10.1097/md.0000000000027084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 08/12/2021] [Indexed: 01/04/2023] Open
Abstract
One of major causes of cervical central stenosis (CCS) is thickened change of cervical ligament flavum (CLF). The association of a morphological parameter called cervical ligament flavum thickness (CLFT) with CCS has not been reported yet. Thus, the purpose of this research was to investigate the relationship between CCS and CFJT.Data were obtained from 88 patients with CCS. A total of 87 normal controls also underwent cervical spine magnetic resonance imaging (CSMRI). All subjects underwent axial T2-weighted CSMRI. Using our picture archiving and communications system, thickness of ligament flavum of the cervical spine at C6/7 level was analyzed.The mean CLFT was 1.41 ± 0.24 mm in normal subjects and 2.09 ± 0.39 mm in patients with CCS. The CCS group was found to have significantly (P < .001) higher rate of CLFT than normal subjects. ROC curves were used to assess the usefulness of CLFT as a predictor of CCS. In the CCS group, the best practical cut off-point of CLFT was 1.71 mm (sensitivity = 90.9%; specificity = 90.8%), with AUC of 0.94 (95% confidence interval: 0.90--0.98).Greater CLFT values were associated with greater possibility of CCS. Thus, treating physician should carefully examine CLFT, as it can help diagnose CCS.
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Affiliation(s)
- Hye-Won Jeong
- Department of Anesthesiology and Pain Medicine, Catholic Kwandong University, College of Medicine, International ST. Mary's Hospital, Incheon, Republic of Korea
| | - Jungmin Yi
- Department of Anesthesiology and Pain Medicine, Catholic Kwandong University, College of Medicine, International ST. Mary's Hospital, Incheon, Republic of Korea
| | - Sooho Lee
- Department of Anesthesiology and Pain Medicine, Catholic Kwandong University, College of Medicine, International ST. Mary's Hospital, Incheon, Republic of Korea
| | - Sukhee Park
- Department of Anesthesiology and Pain Medicine, Catholic Kwandong University, College of Medicine, International ST. Mary's Hospital, Incheon, Republic of Korea
| | - Keum Nae Kang
- Department of Anesthesiology and Pain Medicine, National Police Hospital, Seoul, Republic of Korea
| | - Jonghyuk Lee
- Department of Anesthesiology and Pain Medicine, National Police Hospital, Seoul, Republic of Korea
| | - Hyung Rae Cho
- Department of Anesthesiology and Pain Medine, Myongji Hospital, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Young Uk Kim
- Department of Anesthesiology and Pain Medicine, Catholic Kwandong University, College of Medicine, International ST. Mary's Hospital, Incheon, Republic of Korea
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Moreno AM, Alemán F, Catroli GF, Hunt M, Hu M, Dailamy A, Pla A, Woller SA, Palmer N, Parekh U, McDonald D, Roberts AJ, Goodwill V, Dryden I, Hevner RF, Delay L, Gonçalves Dos Santos G, Yaksh TL, Mali P. Long-lasting analgesia via targeted in situ repression of Na V1.7 in mice. Sci Transl Med 2021; 13:eaay9056. [PMID: 33692134 PMCID: PMC8830379 DOI: 10.1126/scitranslmed.aay9056] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Revised: 08/14/2020] [Accepted: 11/10/2020] [Indexed: 12/12/2022]
Abstract
Current treatments for chronic pain rely largely on opioids despite their substantial side effects and risk of addiction. Genetic studies have identified in humans key targets pivotal to nociceptive processing. In particular, a hereditary loss-of-function mutation in NaV1.7, a sodium channel protein associated with signaling in nociceptive sensory afferents, leads to insensitivity to pain without other neurodevelopmental alterations. However, the high sequence and structural similarity between NaV subtypes has frustrated efforts to develop selective inhibitors. Here, we investigated targeted epigenetic repression of NaV1.7 in primary afferents via epigenome engineering approaches based on clustered regularly interspaced short palindromic repeats (CRISPR)-dCas9 and zinc finger proteins at the spinal level as a potential treatment for chronic pain. Toward this end, we first optimized the efficiency of NaV1.7 repression in vitro in Neuro2A cells and then, by the lumbar intrathecal route, delivered both epigenome engineering platforms via adeno-associated viruses (AAVs) to assess their effects in three mouse models of pain: carrageenan-induced inflammatory pain, paclitaxel-induced neuropathic pain, and BzATP-induced pain. Our results show effective repression of NaV1.7 in lumbar dorsal root ganglia, reduced thermal hyperalgesia in the inflammatory state, decreased tactile allodynia in the neuropathic state, and no changes in normal motor function in mice. We anticipate that this long-lasting analgesia via targeted in vivo epigenetic repression of NaV1.7 methodology we dub pain LATER, might have therapeutic potential in management of persistent pain states.
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Affiliation(s)
- Ana M Moreno
- Department of Bioengineering, University of California San Diego, San Diego, CA 92093, USA
| | - Fernando Alemán
- Department of Bioengineering, University of California San Diego, San Diego, CA 92093, USA
| | - Glaucilene F Catroli
- Department of Anesthesiology, University of California San Diego, San Diego, CA 92093, USA
| | - Matthew Hunt
- Department of Anesthesiology, University of California San Diego, San Diego, CA 92093, USA
| | - Michael Hu
- Department of Bioengineering, University of California San Diego, San Diego, CA 92093, USA
| | - Amir Dailamy
- Department of Bioengineering, University of California San Diego, San Diego, CA 92093, USA
| | - Andrew Pla
- Department of Bioengineering, University of California San Diego, San Diego, CA 92093, USA
| | - Sarah A Woller
- Department of Anesthesiology, University of California San Diego, San Diego, CA 92093, USA
| | - Nathan Palmer
- Division of Biological Sciences, University of California San Diego , San Diego, CA 92093, USA
| | - Udit Parekh
- Department of Electrical Engineering, University of California San Diego , San Diego, CA 92093, USA
| | - Daniella McDonald
- Department of Bioengineering, University of California San Diego, San Diego, CA 92093, USA
- Biomedical Sciences Graduate Program, University of California San Diego, San Diego, San Diego, CA 92093, USA
| | - Amanda J Roberts
- Animal Models Core, Scripps Research Institute, La Jolla, CA 92037, USA
| | - Vanessa Goodwill
- Department of Neuropathology, University of California San Diego, San Diego, CA 92093, USA
| | - Ian Dryden
- Department of Neuropathology, University of California San Diego, San Diego, CA 92093, USA
| | - Robert F Hevner
- Department of Neuropathology, University of California San Diego, San Diego, CA 92093, USA
| | - Lauriane Delay
- Department of Anesthesiology, University of California San Diego, San Diego, CA 92093, USA
| | | | - Tony L Yaksh
- Department of Anesthesiology, University of California San Diego, San Diego, CA 92093, USA.
| | - Prashant Mali
- Department of Bioengineering, University of California San Diego, San Diego, CA 92093, USA.
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Analysis of Subdural Injection During Lumbar Interlaminar Epidural Injection in Failed Back Surgery Syndrome. J Clin Med 2020; 9:jcm9103132. [PMID: 32998267 PMCID: PMC7599714 DOI: 10.3390/jcm9103132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Revised: 09/02/2020] [Accepted: 09/22/2020] [Indexed: 11/16/2022] Open
Abstract
Persistent or recurrent back and leg pain following spinal surgery, known as failed back surgery syndrome (FBSS), significantly limits daily life activities. A lumbar epidural injection can reduce adhesions, inflammation, and nerve compression, although the epidural space can be distorted due to dura mater and epidural tissues changes after spinal surgery. This study analyzed subdural injection during lumbar epidural injection in FBSS patients. We retrospectively analyzed data from 155 patients who received a lumbar interlaminar epidural injection to manage FBSS. We grouped the patients based on the injected contrast medium appearance in the subdural (group S) or epidural spaces (group E) in fluoroscopic contrast images. Demographic, clinical, surgical and fluoroscopic data were recorded and evaluated, as were the pain scores before and after injection. There were 59 patients (38.1%) in the subdural group. Injection distance from the surgery level differed between the groups. Risk of subdural injection at level 1 distance from the surgery level had an odds ratio of 0.374, and at level ≥2, it was 0.172, when compared to level 0. Subdural incidence differed with the distance from surgical site. Physicians should strive to reduce subdural incidence when the injection is planned at surgery site in FBSS.
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Abstract
PURPOSE OF REVIEW Myofascial pain syndrome (MPS) is a musculoskeletal pain condition that stems from localized, taut regions of skeletal muscle and fascia, termed trigger points. The purpose of this comprehensive review is to provide updated information on prevalence, pathophysiology, and treatment modalities with a focus on interventional modalities in managing MPS. RECENT FINDINGS Though MPS can present acutely, it frequently presents as a chronic condition, affecting up to 85% of adults during their lifetime. MPS is an often-overlooked component of pain with overarching effects on society, including patient quality of life, physical and social functioning, emotional well-being, energy, and costs on health care. The prevalence of MPS is generally increased among patients with other chronic pain disorders and has been associated with various other conditions such as bladder pain syndrome, endometriosis, and anxiety. MPS is poorly understood and remains a challenging condition to treat. Non-pharmacologic treatment modalities such as acupuncture, massage, transcutaneous electrical stimulation, and interferential current therapy may offer relief to some patients with MPS. Additional studies are warranted to get a better understanding of managing myofascial pain.
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Does Epidural Bupivacaine with or Without Steroids Provide Long-Term Relief? A Systematic Review and Meta-analysis. Curr Pain Headache Rep 2020; 24:26. [DOI: 10.1007/s11916-020-00859-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Zhao L, Manchikanti L, Kaye AD, Abd-Elsayed A. Treatment of Discogenic Low Back Pain: Current Treatment Strategies and Future Options—a Literature Review. Curr Pain Headache Rep 2019; 23:86. [DOI: 10.1007/s11916-019-0821-x] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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