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Niemeyer CS, Harlander-Locke M, Bubak AN, Rzasa-Lynn R, Birlea M. Trigeminal Postherpetic Neuralgia: From Pathophysiology to Treatment. Curr Pain Headache Rep 2024; 28:295-306. [PMID: 38261232 PMCID: PMC10940365 DOI: 10.1007/s11916-023-01209-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/29/2023] [Indexed: 01/24/2024]
Abstract
PURPOSE OF REVIEW Trigeminal postherpetic neuralgia (TG-PHN) is a neuropathic pain condition complicating herpes zoster (HZ) attributed to the trigeminal nerve. It poses significant challenges due to its persistent and debilitating nature. This review explores the clinical characteristics of TG-PHN, analyzes its pathophysiological underpinnings, and addresses existent and potential therapies. RECENT FINDINGS TG-PHN is one of the most common and complex PHN locations. It has distinguishing clinical and pathophysiological characteristics, starting with viral triggered injuries to the trigeminal ganglion (TG) and peripheral tissue and involving the ascending and descending brain modulation pathways. Current therapies include vaccines, oral and topical medications, and interventional approaches, like nerve blocks and neurostimulation. This review covers TG-PHN's clinical and physiological components, treatment options, and potential future targets for improved management. By exploring the complexities of this condition, we aim to contribute to developing more effective and targeted therapies for patients suffering from trigeminal PHN.
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Affiliation(s)
- Christy S Niemeyer
- Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Michael Harlander-Locke
- Department of Anesthesiology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Andrew N Bubak
- Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Rachael Rzasa-Lynn
- Department of Anesthesiology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Marius Birlea
- Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
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Yoo YM, Kim KH. Current understanding of nociplastic pain. Korean J Pain 2024; 37:107-118. [PMID: 38504389 PMCID: PMC10985487 DOI: 10.3344/kjp.23326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 12/28/2023] [Accepted: 01/09/2024] [Indexed: 03/21/2024] Open
Abstract
Nociplastic pain by the "International Association for the Study of Pain" is defined as pain that arises from altered nociception despite no clear evidence of nociceptive or neuropathic pain. Augmented central nervous system pain and sensory processing with altered pain modulation are suggested to be the mechanism of nociplastic pain. Clinical criteria for possible nociplastic pain affecting somatic structures include chronic regional pain and evoked pain hypersensitivity including allodynia with after-sensation. In addition to possible nociplastic pain, clinical criteria for probable nociplastic pain are pain hypersensitivity in the region of pain to non-noxious stimuli and presence of comorbidity such as generalized symptoms with sleep disturbance, fatigue, or cognitive problems with hypersensitivity of special senses. Criteria for definitive nociplastic pain is not determined yet. Eight specific disorders related to central sensitization are suggested to be restless leg syndrome, chronic fatigue syndrome, fibromyalgia, temporomandibular disorder, migraine or tension headache, irritable bowel syndrome, multiple chemical sensitivities, and whiplash injury; non-specific emotional disorders related to central sensitization include anxiety or panic attack and depression. These central sensitization pain syndromes are overlapped to previous functional pain syndromes which are unlike organic pain syndromes and have emotional components. Therefore, nociplastic pain can be understood as chronic altered nociception related to central sensitization including both sensory components with nociceptive and/or neuropathic pain and emotional components. Nociplastic pain may be developed to explain unexplained chronic pain beyond tissue damage or pathology regardless of its origin from nociceptive, neuropathic, emotional, or mixed pain components.
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Affiliation(s)
- Yeong-Min Yoo
- Department of Anesthesia and Pain Medicine, School of Medicine, Pusan National University, Yangsan, Korea
| | - Kyung-Hoon Kim
- Department of Anesthesia and Pain Medicine, School of Medicine, Pusan National University, Yangsan, Korea
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Celhay O, Roman H, Pasticier G, Calvarin E, Gomez C, Susperregui J, Palamara C, Michiels C. Combined Decompression of Pudendal and Inferior Cluneal Nerves for Entrapment Neuralgias Using Transperitoneal Robotic Laparoscopy: Feasibility and Our 4 Step Technique. J Minim Invasive Gynecol 2024:S1553-4650(24)00152-3. [PMID: 38527704 DOI: 10.1016/j.jmig.2024.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Revised: 02/07/2024] [Accepted: 03/22/2024] [Indexed: 03/27/2024]
Abstract
OBJECTIVE To demonstrate the feasibility of a combined decompression of pudendal and inferior cluneal nerves for entrapment syndrome using a transperitoneal robotic laparoscopy. DESIGN Demonstration of our 4-step technique with narrated video footage. SETTING Pudendal and inferior cluneal neuralgias caused by an entrapment syndrome are both responsible for perineal pain [1]. Although more precise data are lacking, these 2 neuralgias are frequently associated. Failure of surgical pudendal nerve decompression in the early 2000 has driven to discover the entity of a potential entrapment syndrome of the posterior cutaneous nerve of the tight and its inferior cluneal branches between the ischium bone and the sacrotuberous ligament [2]. The corresponding neuralgia is responsible for a neuropathic pain to a more posterior part of the perineum and the thigh, without any neurovegetative symptom. In case of failure of medical treatment, surgery can be proposed using an invasive open transgluteal approach as a standard treatment [3-5]. INTERVENTIONS Transperitoneal robotic laparoscopy for a mini-invasive releasing of both pudendal and inferior cluneal nerves, following a 4-step technique: 1. Opening of the peritoneum between the external iliac vessels and the umbilical ligament 2. Dissection of the internal iliac and pudendal arteries up to the pudendal nerve 3. Section of the sacrospinous ligament and release of the pudendal nerve 4. Section of the sacrotuberous ligament and release of the inferior cluneal nerve CONCLUSION: Previously, pudendal and inferior cluneal neuralgias have been managed with an invasive open transgluteal surgery. Here, we demonstrate the feasibility of a mini-invasive transperitoneal robotic laparoscopy, with a standardized 4-step surgical technique. VIDEO ABSTRACT.
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Affiliation(s)
- Olivier Celhay
- Department of Urology and Robotic Surgery, Clinique Tivoli-Ducos (Drs. Celhay, Pasticier, Susperregui, Palamara, and Michiels), Bordeaux, France.
| | - Horace Roman
- IFEMEndo, Clinique Tivoli-Ducos (Dr. Roman), Bordeaux, France
| | - Gilles Pasticier
- Department of Urology and Robotic Surgery, Clinique Tivoli-Ducos (Drs. Celhay, Pasticier, Susperregui, Palamara, and Michiels), Bordeaux, France
| | - Estelle Calvarin
- Physiotherapy Center of Parc Rivière (Calvarin), Bordeaux, France
| | | | - Jocelyn Susperregui
- Department of Urology and Robotic Surgery, Clinique Tivoli-Ducos (Drs. Celhay, Pasticier, Susperregui, Palamara, and Michiels), Bordeaux, France
| | - Corinne Palamara
- Department of Urology and Robotic Surgery, Clinique Tivoli-Ducos (Drs. Celhay, Pasticier, Susperregui, Palamara, and Michiels), Bordeaux, France
| | - Clément Michiels
- Department of Urology and Robotic Surgery, Clinique Tivoli-Ducos (Drs. Celhay, Pasticier, Susperregui, Palamara, and Michiels), Bordeaux, France
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Wang A, Bian J, Li N, Ni J, Zila L, Tang Y. Analyzing the Effect of Intraoperative Stimulation Voltage on Facial Numbness Following Radiofrequency Thermocoagulation in the Treatment of Idiopathic Trigeminal Neuralgia. Pain Ther 2024:10.1007/s40122-024-00587-5. [PMID: 38489096 DOI: 10.1007/s40122-024-00587-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 02/19/2024] [Indexed: 03/17/2024] Open
Abstract
INTRODUCTION Radiofrequency thermocoagulation (RFT) effectively alleviates idiopathic trigeminal neuralgia (ITN); however, postoperative facial numbness poses a significant challenge. This issue arises due to the close proximity of high-temperature thermocoagulation, which not only ablates pain-related nociceptive fibers but also affects tactile fibers. Intraoperative sensory stimulation voltage (SV), which reflects the distance between the RFT cannula and the target nerve, potentially possesses the ability to prevent tactile fiber injury. This study aimed to investigate the influence of SV on postoperative facial numbness and provide valuable insights to mitigate its occurrence. METHODS A retrospective analysis was performed on 72 ITN patients with maxillary division (V2) pain who underwent RFT between 2020 and 2022. Among them, 13 patients with SV ≤ 0.2 V constituted the low SV group. Subsequently, a matched-cohort analysis was conducted on the remaining 59 patients. The patients paired with the low SV patients were subsequently enrolled in the high SV group, adhering to a 1:1 match ratio. The primary outcome was the facial numbness scale assessment at 3 days, 3 months and 6 months post-surgery. The pain intensity and medication burden served as the secondary outcomes. RESULTS We successfully matched a cohort consisting of 12 patients in the low SV group and 12 patients in the high SV group. Each patient experienced various degrees of facial numbness at 3 days post-RFT. Notably, the low SV group exhibited a higher incidence of moderate numbness (66.7% vs. 16.67%, P = 0.036), whereas the high SV group had more cases of mild numbness at the 6-month follow-up (25% vs. 83.3%, P = 0.012). Both groups demonstrated significant decreases in pain intensity and medication burden compared to before the operation. CONCLUSIONS SV proved to be a reliable parameter for mitigating the degree of postoperative facial numbness in RFT treatment for ITN. A relatively high sensory SV ranging from 0.3 to 0.6 V during the RFT procedure results in less facial numbness in the treatment of ITN.
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Affiliation(s)
- Aitao Wang
- Department of Pain Management, Huhhot First Hospital, Inner Mongolia, China
- Department of Pain Management, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Beijing, 100053, China
| | - Jingjing Bian
- Department of Pain Management, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Beijing, 100053, China
- Department of Anesthesiology, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Na Li
- Department of Pain Management, Huhhot First Hospital, Inner Mongolia, China
- Department of Pain Management, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Beijing, 100053, China
| | - Jiaxiang Ni
- Department of Pain Management, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Beijing, 100053, China
| | - Lea Zila
- Board of Governors Regenerative Medicine Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Yuanzhang Tang
- Department of Pain Management, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Beijing, 100053, China.
- Board of Governors Regenerative Medicine Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
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Silva AI, Barbosa M, Barbosa P, Guimarães L, Gomes A. Spinal Cord Stimulation in Refractory Postherpetic Neuralgia in Portugal: A Case Report. ACTA MEDICA PORT 2024. [PMID: 38380678 DOI: 10.20344/amp.20524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 11/28/2023] [Indexed: 02/22/2024]
Abstract
Postherpetic neuralgia is one of the most severe complications after herpes zoster infection. Patients who experience persistent pain despite conservative treatment may benefit from interventional therapies, such as spinal cord stimulation. We present the case of a patient with severe refractory postherpetic neuralgia in the right T8 to L1 distribution who responded effectively to spinal cord stimulation. After its implantation, the patient had improvements in pain intensity, pain-related interference, quality of life, and satisfaction, with a simultaneous reduction of previous medications. This case report highlights the role of spinal cord stimulation in refractory neuropathic pain secondary to herpes zoster.
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Affiliation(s)
- Ana Inês Silva
- Department of Anesthesiology. Centro Hospitalar Universitário de São João. Porto. .
| | - Margarida Barbosa
- Department of Anesthesiology. Centro Hospitalar Universitário de São João. Porto; Faculty of Medicine. Universidade do Porto. Porto. Portugal
| | - Paula Barbosa
- Department of Anesthesiology. Centro Hospitalar Universitário de São João. Porto. Portugal
| | - Luís Guimarães
- Department of Anesthesiology. Centro Hospitalar Universitário de São João. Porto; Faculty of Medicine. Universidade do Porto. Porto. Portugal
| | - Armanda Gomes
- Department of Anesthesiology. Centro Hospitalar Universitário de São João. Porto. Portugal
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Perdecioğlu GRG, Ateş MP, Yürük D, Akkaya ÖT. Neuromodulation of the median nerve in carpal tunnel syndrome, a single-blind, randomized controlled study. Korean J Pain 2024; 37:34-40. [PMID: 38061772 PMCID: PMC10764211 DOI: 10.3344/kjp.23232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 09/20/2023] [Accepted: 09/21/2023] [Indexed: 12/30/2023] Open
Abstract
Background This study aimed to evaluate the efficacy of pulsed radiofrequency applied using transcutaneous electrodes in carpal tunnel syndrome (CTS). Methods After randomization, the patients received two cycles of noninvasive pulsed radiofrequency (NiPRF), once weekly, or splinting (the control group) for three months. Clinical evaluations were recorded at baseline and weeks 4 and 8. The Boston Carpal Tunnel Syndrome Questionnaire (BCTQ) was used to determine the functional status and symptom severity. Results Sixty-two patients were followed up for three months. There was no difference between the groups in the BCTQ scores before and after treatment. The NiPRF group found a significant difference between the BCTQ measurements at all time intervals (paired sample t -test; P < 0.001). In the splint group, there was a significant difference only between the basal-1st month and basal-3rd month (paired samples t -test; P < 0.001). The main effect of the time variable was statistically significant (ANOVA; P < 0.001), but the group variable was not. There was no correlation between the BCTQ results measured at any time and the electroneuromyelogragphy findings in either group. Conclusions NiPRF effectively improves symptoms and functionality in patients with CTS for up to 3 months. Thus, NiPRF can be considered an easy, safe, and useful alternative treatment modality for CTS.
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Affiliation(s)
| | | | - Damla Yürük
- Department of Algology, Etlik City Hospital, Ankara, Turkey
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Kiedrowski M. Tapentadol helps in trigeminal neuralgia: a case report. Ann Palliat Med 2024; 13:178-182. [PMID: 37953213 DOI: 10.21037/apm-23-439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Accepted: 09/13/2023] [Indexed: 11/14/2023]
Abstract
BACKGROUND Trigeminal neuralgia (TN) usually affects people over 50 years old. TN-related pains are short-lived, and the disease course is characterized by exacerbations and remissions. Sometimes chronic pain develops due to central sensitization. This is the first case report on the effectiveness of tapentadol in pain control in TN. CASE DESCRIPTION It is an instructive case history demonstrating the high effectiveness of tapentadol in a 55-year-old Caucasian male with severe [Visual Analogue Scale (VAS) 9/10] TN-related pain and a history of ineffective treatment with antiepileptic drugs. The neuralgia had occurred twice a year for the three preceding years, and typically the TN periods lasted 2-3 weeks with complete remissions between. Previously the patient had been treated with antiepileptic drugs (e.g., carbamazepine, phenytoin, clonazepam, gabapentin, and lamotrigine). However, he found all treatments to be ineffective and accompanied by unacceptable somnolence. Thus, a prolonged-release oral tapentadol was proposed at the beginning of the next relapse. After application of tapentadol, the patient reported a significant improvement. The severity of pain declined to VAS 6/10 (2nd day) and 4/10 (3rd day), and the attacks resolved entirely on the fourth day of treatment. He reported no side effects. The drug was discontinued after 14 days. CONCLUSIONS Despite pain chronification, tapentadol was efficient and well tolerated in TN. Further research is needed to reveal tapentadol's efficacy in neuralgias.
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Affiliation(s)
- Mirosław Kiedrowski
- Clinical Department of Oncology, The National Institute of Medicine of the Ministry of Interior and Administration, Warsaw, Poland; Ewdomed Hospice and Foundation, Konstancin-Jeziorna, Poland
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Vali R, Azadi A, Tizno A, Farkhondeh T, Samini F, Samarghandian S. miRNA contributes to neuropathic pains. Int J Biol Macromol 2023; 253:126893. [PMID: 37730007 DOI: 10.1016/j.ijbiomac.2023.126893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 08/29/2023] [Accepted: 09/11/2023] [Indexed: 09/22/2023]
Abstract
Neuropathic pain (NP) is a kind of chronic pain caused by direct injury to the peripheral or central nervous system (CNS). microRNAs (miRNAs) are small noncoding RNAs that mostly interact with the 3 untranslated region of messenger RNAs (mRNAs) to regulate the expression of multiple genes. NP is characterized by changes in the expression of receptors and mediators, and there is evidence that miRNAs may contribute to some of these alterations. In this review, we aimed to fully comprehend the connection between NP and miRNA; and also, to establish a link between neurology, biology, and dentistry. Studies have shown that targeting miRNAs may be an effective therapeutic strategy for the treatment of chronic pain and potential target for the prevention of NP.
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Affiliation(s)
- Reyhaneh Vali
- Department of Biology, Faculty of Modern Science, Tehran Medical Branch, Islamic Azad University, Tehran, Iran; Noncommunicable Diseases Research Center, Neyshabur University of Medical Sciences, Neyshabur, Iran
| | - Ali Azadi
- Dental Research Center, Research Institute of Dental Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ashkan Tizno
- Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Tahereh Farkhondeh
- Neuroscience Research Center, Kamyab Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Fariborz Samini
- Department of Toxicology and Pharmacology, School of Pharmacy, Birjand University of Medical Sciences, Birjand, Iran
| | - Saeed Samarghandian
- Department of Toxicology and Pharmacology, School of Pharmacy, Birjand University of Medical Sciences, Birjand, Iran.
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HajAli T, Shmaisani A, Fares Y, Abou-Abbas L. Predictors of neuropathic pain and related functional disability in sciatica patients: a cross-sectional study. Int J Neurosci 2023; 133:1338-1345. [PMID: 35603462 DOI: 10.1080/00207454.2022.2079504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 05/12/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE The aim of the present paper was to assess neuropathic pain and its predictors among patients with sciatica. In addition, we sought to investigate the predictors of functional disability in sciatica patients with neuropathic pain. METHODS A cross-sectional study was carried out on a sample of 100 sciatica patients aged 18 years and older with a radiating pain from the lower back down to the leg below the knee. Information about socio-demographic characteristics, duration of symptoms, being treated or not, type of treatment, side of sciatica, presence of back pain, leg pain occurrence, leg pain intensity, functional disability and pain catastrophizing were collected. RESULTS Of the total patients, 57% had neuropathic pain. Multivariable analysis showed that leg pain intensity was higher in the neuropathic pain group as compared to the non-neuropathic pain group. Also, patients with left sciatica were less likely to have neuropathic pain than patients with right sciatica. Patients with neuropathic pain having high levels of pain catastrophizing and being on bed rest for at least one week were at a higher risk of developing functional disability as compared to their counterparts. CONCLUSION Low levels of pain catastrophizing and less bed rest should be considered in interventions aimed at improving the functional ability for sciatica patients with neuropathic pain.
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Affiliation(s)
- Thuraya HajAli
- Neuroscience Research Center, Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
| | - Ammar Shmaisani
- Neurosurgery Department, Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
| | - Youssef Fares
- Neuroscience Research Center, Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
- Neurosurgery Department, Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
| | - Linda Abou-Abbas
- Neuroscience Research Center, Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
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Zhang T, Liang W, Ou W, Zhang M, Cui S, Zhang S. Daphnetin alleviates neuropathic pain in chronic constrictive injury rats via regulating the NF-κB dependent CXCL1/CXCR2 signaling pathway. Pharm Biol 2023; 61:746-754. [PMID: 37177984 PMCID: PMC10184651 DOI: 10.1080/13880209.2023.2198560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
CONTEXT Daphnetin is a natural product with anti-inflammatory, antioxidant, and neuroprotective properties. Reports have found that it has a strong analgesic effect; however, its analgesic mechanism is unknown. OBJECTIVE We explored the effect and mechanism of daphnetin on neuropathic pain (NP). MATERIALS AND METHODS The rat model of NP was established by ligation of the sciatic nerve. Male Sprague-Dawley rats were divided into six groups: Control, Model, Sham, morphine (0.375 mg/kg), and daphnetin (0.0625 and 0.025 mg/kg). Rats were intrathecally injected with drugs or normal saline once daily for three days. Hyperalgesia was evaluated by mechanical withdrawal threshold (MWT) and thermal withdrawal threshold (TWT). Protein levels were detected using ELISA, immunofluorescence, and western blotting. RESULTS Compared to the Model group, daphnetin improved TWT (46.70 °C vs. 42.20 °C) and MWT (45.60 g vs. 23.60 g), reduced the expression of interleukin-1β (0.99 ng/g vs. 1.42 ng/g), interleukin-6 (0.90 ng/g vs. 1.52 ng/g), and tumor necrosis factor-α (0.93 ng/g vs. 1.52 ng/g) in the sciatic nerve. Daphnetin decreased the expression of toll-like receptor 4 (TLR4) (0.47-fold), phosphorylated inhibitor of NF-κB (p-IKBα) (0.29-fold), nuclear factor kappaB (NF-κB) (0.48-fold), glial fibrillary acidic protein (GFAP) (0.42-fold), CXC chemokine ligand type 1 (CXCL1) (0.84-fold), CXC chemokine receptor type 2 (CXCR2) (0.78-fold) in the spinal cord. DISCUSSION AND CONCLUSIONS Daphnetin alleviates NP by inhibiting inflammation and astrocyte activation in the spinal cord, providing theoretical support for the extensive clinical treatment of NP.
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Affiliation(s)
- Tianrui Zhang
- Department of Pharmacology of Traditional Chinese Medicine, College of Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Wulin Liang
- Department of Pharmacology of Traditional Chinese Medicine, College of Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Wenjing Ou
- Department of Pharmacology of Traditional Chinese Medicine, College of Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Mingqian Zhang
- Department of Pharmacology of Traditional Chinese Medicine, College of Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Shuang Cui
- Department of Pharmacology of Traditional Chinese Medicine, College of Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Shuofeng Zhang
- Department of Pharmacology of Traditional Chinese Medicine, College of Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
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Abd-Elsayed A, Keith MK, Cao NN, Fiala KJ, Martens JM. Temporary Peripheral Nerve Stimulation as Treatment for Chronic Pain. Pain Ther 2023; 12:1415-1426. [PMID: 37737951 PMCID: PMC10616055 DOI: 10.1007/s40122-023-00557-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Accepted: 09/04/2023] [Indexed: 09/23/2023] Open
Abstract
INTRODUCTION Chronic pain is a growing problem across the world, and in the midst of an opioid epidemic, it is imperative that alternative treatment measures are identified to help alleviate the pain experienced by these patients. Chronic pain greatly affects ones quality of life and many patients do not experience adequate relief with conventional treatment measures. The purpose of this retrospective analysis is to assess the efficacy of peripheral nerve stimulation (PNS) therapy in adult patients suffering from chronic pain refractory to conventional treatment measures who underwent therapy on various anatomical locations. METHODS This retrospective analysis consisted of data collected from electronic health records for n = 89 patients who underwent PNS therapy. Data collected relates to patient age, sex, weight, height, body mass index (BMI), diagnosis, targeted nerves, follow-up encounters, pain scores from before and after PNS therapy, and duration of improvement. Statistical analysis used SPSS software, version 26 (IBM), using a paired t test to assess significance between pre and post PNS therapy pain scores. P values were significant if found to be ≤ 0.05. Further analysis assessed the correlation between age and BMI with visual analog scale (VAS) pain improvement and subjective percentage pain relief. RESULTS The mean pre-operative (pre-op) pain score before PNS therapy was 6.36 (standard deviation (SD) = 2.18, SEM = 0.23) and the mean post-operative (post-op) pain score after PNS therapy was 4.19 (SD = 2.70, SEM = 0.29). The mean patient-reported percent improvement in pain following PNS therapy was 49.04% (SD = 34.79). The improvement in pain scores between pre-op and post-op was statistically significant (M = 2.17, SD = 2.82, SEM = 0.30, t(88) = 7.26, p < .001), 95% confidence interval (CI) [1.57, 2.76]. The mean duration of improvement for patients was 123 days after therapy initiation (min = 6, max = 683, SD = 126). CONCLUSIONS This study demonstrated the potential role for PNS therapy in improving patient-reported pain levels for various neuropathies, targeting various nerves. With PNS therapy's use as a chronic pain treatment and available research being limited, further study needs to be done on the efficacy of PNS therapy for pain management and complications associated with PNS device placements at various locations.
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Affiliation(s)
- Alaa Abd-Elsayed
- Department of Anesthesiology, Division of Chronic Pain Medicine, University of Wisconsin-Madison School of Medicine and Public Health, 600 Highland Avenue, B6/319 CSC, Madison, WI, 53792-3272, USA.
| | - Mitchell K Keith
- Department of Anesthesiology, Division of Chronic Pain Medicine, University of Wisconsin-Madison School of Medicine and Public Health, 600 Highland Avenue, B6/319 CSC, Madison, WI, 53792-3272, USA
| | - Nancy N Cao
- Department of Anesthesiology, Division of Chronic Pain Medicine, University of Wisconsin-Madison School of Medicine and Public Health, 600 Highland Avenue, B6/319 CSC, Madison, WI, 53792-3272, USA
| | - Kenneth J Fiala
- Department of Anesthesiology, Division of Chronic Pain Medicine, University of Wisconsin-Madison School of Medicine and Public Health, 600 Highland Avenue, B6/319 CSC, Madison, WI, 53792-3272, USA
| | - Joshua M Martens
- Department of Anesthesiology, Division of Chronic Pain Medicine, University of Wisconsin-Madison School of Medicine and Public Health, 600 Highland Avenue, B6/319 CSC, Madison, WI, 53792-3272, USA
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Shi T, Yu Z, Chen Z, Wu D, Wang Z, Liu W. The impact of time from injury to surgery on the risk of neuropathic pain after traumatic spinal cord injury. J Orthop Surg Res 2023; 18:857. [PMID: 37951909 PMCID: PMC10638760 DOI: 10.1186/s13018-023-04355-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 11/07/2023] [Indexed: 11/14/2023] Open
Abstract
Traumatic spinal cord injury (SCI) is a devastating neurological disorder often accompanied by neuropathic pain (NeP), significantly affecting patients' quality of life. This retrospective study aimed to investigate the impact of the time from injury to surgery on the development of NeP following traumatic SCI. Medical records of patients with traumatic SCI who underwent surgical intervention between January 2017 and January 2021 at two specialized centers were reviewed. Variables associated with NeP including demographics, injury profiles, medical history, surgical details, and pain assessments were investigated. Independent risk factors related to NeP were identified using multivariate logistic regression analysis. A total of 320 patients met the inclusion criteria, with 245 (76.6%) being male and a mean age of 56.5 ± 13.2 years. NeP was identified in 48.4% of patients (155 of 320). The multivariate analysis identifies age at injury, Injury Severity Score, and the neurological level of injury as independent risk factors for the development of NeP in both AIS A and AIS B, C, and D subgroups. Additionally, a significant association between the time from injury to surgery and NeP was observed in AIS B, C, and D patients, while no such association was found in AIS A patients. This study highlights the benefits of early and ultra-early surgical intervention in preventing NeP in patients with incomplete traumatic SCI (AIS B, C, and D), underscoring the importance of optimizing surgical timing to improve patient outcomes. Prospective studies are warranted to establish evidence-based surgical guidelines for managing traumatic SCI and preventing NeP effectively.
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Affiliation(s)
- Tengbin Shi
- Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou, 350000, China
- Department of Orthopedics, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou, 350000, China
| | - Zhengxi Yu
- Department of Minimally Invasive Spinal Surgery, The Affiliated Hospital of Putian University, No. 999 Dongzhen East Road, Licheng District, Putian, 351100, China
| | - Zhi Chen
- Department of Orthopedics, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou, 350000, China
| | - Dingwei Wu
- Department of Orthopedics, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou, 350000, China
| | - Zhenyu Wang
- Department of Orthopedics, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou, 350000, China
| | - Wenge Liu
- Department of Orthopedics, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou, 350000, China.
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Narita M, Moriyoshi K, Yamaoka R, Moriyama M, Degawa K, Fushitani M, Kojima H, Suenaga T, Nakanishi H, Nishikawa G, Nakanishi Y, Hata H. Intraneural fibrosis within ilioinguinal nerve in inguinal hernia patients with preoperative pain: it's the sign of irreversible nerve injury, isn't it? Langenbecks Arch Surg 2023; 408:431. [PMID: 37940752 DOI: 10.1007/s00423-023-03158-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 10/17/2023] [Indexed: 11/10/2023]
Abstract
PURPOSE Preoperative pain is known as one of the most powerful risk factors for chronic postoperative inguinal pain (CPIP), while its pathogenesis has not been fully elucidated. The aim of the present study was to evaluate patients with preoperative pain from the pathological perspective and discuss the potential pathogenesis of CPIP in those patients. METHODS This was a single-institutional retrospective study. The study population was inguinal hernia patients with preoperative pain who underwent open anterior hernia repair for primary inguinal hernia with pragmatic ilioinguinal neurectomy during surgery between March 2021 and March 2023. The primary and secondary outcomes were proportion of collagen deposition and mucus accumulation within ilioinguinal nerve in those patients, respectively, which were evaluated histologically using Image J software. RESULTS Forty patients were evaluated. Median value of proportion of intraneural collagen deposition was 38.3% (27.7-95.9). These values were positively correlated with the duration of pain (r2=0.468, P<0.001). Median value of proportion of mucus accumulation in ilioinguinal nerve was 50.1% (0-82.0). These values had no correlation with any clinicopathological variables. CONCLUSIONS In the present study population, all patients with preoperative pain had intraneural fibrosis within ilioinguinal nerve, and its degree had a positive correlation with the pain duration.
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Affiliation(s)
- Masato Narita
- Department of Surgery, Kyoto Medical Center, 1-1 Fukakusamukaihata-cho, Fushimi-ku, Kyoto, 6128555, Japan.
- Department of Surgery, Kobe City Medical Center General Hospital, Kobe City, Japan.
| | - Koki Moriyoshi
- Department of Diagnostic Pathology, Kyoto Medical Center, 1-1 Fukakusamukaihata-cho, Fushimi-ku, Kyoto, 6128555, Japan
| | - Ryoya Yamaoka
- Department of Surgery, Kyoto Medical Center, 1-1 Fukakusamukaihata-cho, Fushimi-ku, Kyoto, 6128555, Japan
| | - Masaaki Moriyama
- Department of Surgery, Kyoto Medical Center, 1-1 Fukakusamukaihata-cho, Fushimi-ku, Kyoto, 6128555, Japan
| | - Kanako Degawa
- Department of Surgery, Kyoto Medical Center, 1-1 Fukakusamukaihata-cho, Fushimi-ku, Kyoto, 6128555, Japan
| | - Masashi Fushitani
- Department of Surgery, Kyoto Medical Center, 1-1 Fukakusamukaihata-cho, Fushimi-ku, Kyoto, 6128555, Japan
| | - Hiroya Kojima
- Department of Surgery, Kyoto Medical Center, 1-1 Fukakusamukaihata-cho, Fushimi-ku, Kyoto, 6128555, Japan
| | - Takahiro Suenaga
- Department of Surgery, Kyoto Medical Center, 1-1 Fukakusamukaihata-cho, Fushimi-ku, Kyoto, 6128555, Japan
| | - Hiroki Nakanishi
- Department of Surgery, Kyoto Medical Center, 1-1 Fukakusamukaihata-cho, Fushimi-ku, Kyoto, 6128555, Japan
| | - Gen Nishikawa
- Department of Surgery, Kyoto Medical Center, 1-1 Fukakusamukaihata-cho, Fushimi-ku, Kyoto, 6128555, Japan
| | - Yasutaka Nakanishi
- Department of Surgery, Kyoto Medical Center, 1-1 Fukakusamukaihata-cho, Fushimi-ku, Kyoto, 6128555, Japan
| | - Hiroaki Hata
- Department of Surgery, Kyoto Medical Center, 1-1 Fukakusamukaihata-cho, Fushimi-ku, Kyoto, 6128555, Japan
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14
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Lam CM, Keim SA, Latif U. Novel implantation technique for pudendal nerve peripheral nerve stimulation for treatment of chronic pelvic pain. Reg Anesth Pain Med 2023; 48:567-571. [PMID: 37419506 DOI: 10.1136/rapm-2023-104551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 06/23/2023] [Indexed: 07/09/2023]
Abstract
BACKGROUND Chronic pelvic pain (CPP) is a pervasive, difficult to treat condition affecting up to 26% of the global female and 8.2% of the global male population. Considered a form of chronic regional pain syndrome (CRPS), it is medically complex and often refractory to multimodal management. Neuromodulation has become increasingly popular in treatment of chronic neuropathic pain conditions, including CPP and CRPS. Dorsal column spinal cord stimulation and dorsal root ganglion stimulation have had some success for managing CPP meanwhile peripheral nerve stimulators (PNS) have been suggested as another viable option. However, few studies in the literature have reported successful use of PNS in treatment of CPP. Here, we detail a possible technique for pudendal PNS lead placement for management of CPP. METHOD This article describes a novel cephalad to caudad fluoroscopic guided technique for pudendal nerve PNS lead placement and implantation. RESULTS A cephalad to caudal-medial fluoroscopic guided approach as described within to successfully implant a percutaneous pudendal nerve PNS for management of CPP. CONCLUSIONS The pudendal nerve PNS lead placement technique noted within can be used to avoid many of the important neurovascular structures near the pelvic outlet. Further studies are needed to validate the safety and efficacy of this therapy modality but it may be a viable management option for patients with medically refractory CPP.
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Affiliation(s)
- Christopher M Lam
- Department of Anesthesiology and Pain Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Sarah A Keim
- Department of Surgery, University of Kansas Medical Center, Kansas City, Missouri, USA
| | - Usman Latif
- Department of Anesthesiology and Pain Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA
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15
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Karm MH, Kwon HJ, Shin E, Bae H, Kim YK, Choi SS. Involvement of the spinal γ-aminobutyric acid receptor in the analgesic effects of intrathecally injected hypertonic saline in spinal nerve-ligated rats. Korean J Pain 2023; 36:441-449. [PMID: 37722756 PMCID: PMC10551396 DOI: 10.3344/kjp.23162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 07/26/2023] [Accepted: 08/05/2023] [Indexed: 09/20/2023] Open
Abstract
Background : Hypertonic saline is used for treating chronic pain; however, clinical studies that aid in optimizing therapeutic protocols are lacking. We aimed to determine the concentration of intrathecally injected hypertonic saline at which the effect reaches its peak as well as the underlying γ-aminobutyric acid (GABA) receptor-related antinociceptive mechanism. Methods : Spinal nerve ligation (SNL; left L5 and L6) was performed to induce neuropathic pain in rats weighing 250-300 g. Experiment 1: one week after implanting the intrathecal catheter, 60 rats were assigned randomly to intrathecal injection with 0.45%, 0.9%, 2.5%, 5%, 10%, and 20% NaCl, followed by behavioral testing at baseline and after 30 minutes, 2 hours, 1 day, and 1 week to determine the minimal concentration which produced maximal analgesia. Experiment 2: after determining the optimal intrathecal hypertonic saline concentration, 60 rats were randomly divided into four groups: Sham, hypertonic saline without pretreatment, and hypertonic saline after pretreatment with one of two GABA receptor antagonists (GABAA [bicuculline], or GABAB [phaclofen]). Behavioral tests were performed at weeks 1 and 3 following each treatment. Results : Hypertonic saline at concentrations greater than 5% alleviated SNL-induced mechanical allodynia and had a significant therapeutic effect, while showing a partial time- and dose-dependent antinociceptive effect on thermal and cold hyperalgesia. However, pretreatment with GABA receptor antagonists inhibited the antinociceptive effect of 5% NaCl. Conclusions : This study indicates that the optimal concentration of hypertonic saline for controlling mechanical allodynia in neuropathic pain is 5%, and that its analgesic effect is related to GABAA and GABAB receptors.
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Affiliation(s)
- Myong-Hwan Karm
- Department of Dental Anesthesiology, School of Dentistry and Dental Research Institute, Seoul National University, Seoul, Korea
| | - Hyun-Jung Kwon
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Euiyong Shin
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Honggyoon Bae
- Department of Anesthesiology and Pain Medicine, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea
| | - Young Ki Kim
- Department of Anesthesiology and Pain Medicine, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea
| | - Seong-Soo Choi
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Vyas PS, Kim SW, Castellano JM, Bal JK, Plewniak KM. Uterine Fibroid-Induced Compressive Neuropathy of Lumbar Plexus and Obturator Nerve. CRSLS 2023; 10:e2023.00034. [PMID: 37937278 PMCID: PMC10627345 DOI: 10.4293/crsls.2023.00034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/09/2023]
Abstract
Introduction Uterine fibroids are the most common gynecologic tumors in reproductive-aged women with a prevalence of up to 80%. Symptoms can range from heavy vaginal bleeding and bulk symptoms to, less frequently, deep vein thrombosis and bowel obstruction. Case Description A 32-year-old female patient presented with acute-onset of right groin and knee pain, and difficulty ambulating. A large posterior uterine fibroid was found to be compressing branches of the lumbar plexus, including the obturator nerve. The patient underwent gynecologic evaluation and an urgent laparoscopic myomectomy. Postoperatively, she had significant improvement in neurologic symptoms. She continued physical therapy for residual mild paresthesia and pain with prolonged ambulation. Discussion Large pelvic masses such as uterine fibroids should be considered on the differential diagnosis for acute-onset non-gynecologic symptoms such as compressive neuropathy, which require urgent evaluation and possible surgical management.
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Affiliation(s)
- Pooja S Vyas
- Department of Obstetrics and Gynecology, Montefiore Medical Center, Bronx, NY. (Drs. Vyas, Kim, Bal, and Plewniak)
- Albert Einstein College of Medicine, Bronx, NY. (Drs. Vyas, Kim, Plewniak and Ms. Castellano)
| | - Sun Woo Kim
- Department of Obstetrics and Gynecology, Montefiore Medical Center, Bronx, NY. (Drs. Vyas, Kim, Bal, Plewniak)
- Albert Einstein College of Medicine, Bronx, NY. (Drs. Vyas, Kim, Plewniak and Ms. Castellano)
| | - Julia M Castellano
- Albert Einstein College of Medicine, Bronx, NY. (Drs. Vyas, Kim, Plewniak and Ms. Castellano)
| | - Japjot K Bal
- Department of Obstetrics and Gynecology, Montefiore Medical Center, Bronx, NY. (Drs. Vyas, Kim, Bal, Plewniak)
| | - Kari M Plewniak
- Department of Obstetrics and Gynecology, Montefiore Medical Center, Bronx, NY. (Drs. Vyas, Kim, Bal, Plewniak)
- Albert Einstein College of Medicine, Bronx, NY. (Drs. Vyas, Kim, Plewniak and Ms. Castellano)
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17
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Radiansyah RS, Hadi DW. Repetitive transcranial magnetic stimulation in central post-stroke pain: current status and future perspective. Korean J Pain 2023; 36:408-424. [PMID: 37752663 PMCID: PMC10551398 DOI: 10.3344/kjp.23220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 09/03/2023] [Accepted: 09/14/2023] [Indexed: 09/28/2023] Open
Abstract
Central post-stroke pain (CPSP) is an incapacitating disorder that impacts a substantial proportion of stroke survivors and can diminish their quality of life. Conventional therapies for CPSP, including tricyclic antidepressants, anticonvulsants, and opioids, are frequently ineffective, necessitating the investigation of alternative therapeutic strategies. Repetitive transcranial magnetic stimulation (rTMS) is now recognized as a promising noninvasive pain management method for CPSP. rTMS modulates neural activity through the administration of magnetic pulses to specific cortical regions. Trials analyzing the effects of rTMS on CPSP have generated various outcomes, but the evidence suggests possible analgesic benefits. In CPSP and other neuropathic pain conditions, high-frequency rTMS targeting the primary motor cortex (M1) with figure-eight coils has demonstrated significant pain alleviation. Due to its associaton with analgesic benefits, M1 is the most frequently targeted area. The duration and frequency of rTMS sessions, as well as the stimulation intensity, have been studied in an effort to optimize treatment outcomes. The short-term pain relief effects of rTMS have been observed, but the long-term effects (> 3 months) require further investigation. Aspects such as stimulation frequency, location, and treatment period can influence the efficacy of rTMS and ought to be considered while planning the procedure. Standardized guidelines for using rTMS in CPSP would optimize therapy protocols and improve patient outcomes. This review article provides an up-to-date overview of the incidence, clinical characteristics, outcome of rTMS in CPSP patients, and future perspective in the field.
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Affiliation(s)
- Riva Satya Radiansyah
- Faculty of Medicine and Health, Institut Teknologi Sepuluh Nopember, Surabaya, Indonesia
| | - Deby Wahyuning Hadi
- Department of Neurology, Faculty of Medicine, Universitas Airlangga – Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
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18
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Acevedo-González JC, Taub-Krivoy A. Modification to the Hartel Route Radiofrequency Technique for the Treatment of Trigeminal Neuralgia: A Technical Note. World Neurosurg 2023; 178:14-19. [PMID: 37393995 DOI: 10.1016/j.wneu.2023.06.112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 06/23/2023] [Indexed: 07/04/2023]
Abstract
OBJECTIVE To evaluate a modification to the classical Hartel technique for the treatment of trigeminal neuralgia. METHODS Intraoperative radiographs of 30 patients with trigeminal neuralgia treated with radiofrequency were retrospectively reviewed. The distance between the needle and the anterior edge of the temporomandibular joint (TMJ) was measured on strict lateral skull radiographs. Surgical time was reviewed, and clinical outcomes were evaluated. RESULTS All patients showed clinical improvement in pain (Visual Analog Scale). In all radiographs, the measurement between the needle and the anterior edge of the TMJ ranged from 10 mm to 22 mm. None of the measurements were below 10 mm or above 22 mm. In most cases, this distance was 18 mm (9 patients), followed by 16 mm in 5 patients. CONCLUSIONS Considering the inclusion of the oval foramen in a Cartesian coordinate system with axes X, Y, and Z is useful. Directing the needle to a point located 1 cm from the anterior edge of the TMJ, avoiding the medial aspect of the upper jaw ridge, allows for a safer and faster procedure.
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Affiliation(s)
- Juan Carlos Acevedo-González
- Department of Neurosurgery, Functional Neurosurgery, Pain Management, and Spasticity, San Ignacio University Hospital, Pontifical Xaverian University, Bogotá, Colombia
| | - Alex Taub-Krivoy
- Medical Student and Director of the Neurosurgery Research Group at San Ignacio University Hospital, Pontifical Xaverian University, Bogotá, Colombia.
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19
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Ramawad HA, Paridari P, Jabermoradi S, Gharin P, Toloui A, Safari S, Yousefifard M. Muscimol as a treatment for nerve injury-related neuropathic pain: a systematic review and meta-analysis of preclinical studies. Korean J Pain 2023; 36:425-440. [PMID: 37732408 PMCID: PMC10551397 DOI: 10.3344/kjp.23161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 07/27/2023] [Accepted: 08/01/2023] [Indexed: 09/22/2023] Open
Abstract
Background : Muscimol's quick onset and GABAergic properties make it a promising candidate for the treatment of pain. This systematic review and meta-analysis of preclinical studies aimed at summarizing the evidence regarding the efficacy of muscimol administration in the amelioration of nerve injury-related neuropathic pain. Methods : Two independent researchers performed the screening process in Medline, Embase, Scopus and Web of Science extracting data were extracted into a checklist designed according to the PRISMA guideline. A standardized mean difference (SMD [95% confidence interval]) was calculated for each. To assess the heterogeneity between studies, I2 and chi-square tests were utilized. In the case of heterogeneity, meta-regression and subgroup analyses were performed to identify the potential source. Results : Twenty-two articles met the inclusion criteria. Pooled data analysis showed that the administration of muscimol during the peak effect causes a significant reduction in mechanical allodynia (SMD = 1.78 [1.45-2.11]; P < 0.0001; I2 = 72.70%), mechanical hyperalgesia (SMD = 1.62 [1.28-1.96]; P < 0.0001; I2 = 40.66%), and thermal hyperalgesia (SMD = 2.59 [1.79-3.39]; P < 0.0001; I2 = 80.33%). This significant amendment of pain was observed at a declining rate from 15 minutes to at least 180 minutes post-treatment in mechanical allodynia and mechanical hyperalgesia, and up to 30 minutes in thermal hyperalgesia (P < 0 .0001). Conclusions : Muscimol is effective in the amelioration of mechanical allodynia, mechanical hyperalgesia, and thermal hyperalgesia, exerting its analgesic effects 15 minutes after administration for up to at least 3 hours.
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Affiliation(s)
- Hamzah Adel Ramawad
- Department of Emergency Medicine, NYC Health + Hospitals, Coney Island, NY, USA
| | - Parsa Paridari
- Physiology Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Sajjad Jabermoradi
- Physiology Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Pantea Gharin
- Physiology Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Amirmohammad Toloui
- Physiology Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Saeed Safari
- Men's Health and Reproductive Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mahmoud Yousefifard
- Physiology Research Center, Iran University of Medical Sciences, Tehran, Iran
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20
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Silva-Ortiz VM. Comments on: Pulsed radiofrequency treatment of the Gasserian ganglion for trigeminal neuralgia - a retrospective study (PROGRESS). Reg Anesth Pain Med 2023:rapm-2023-104858. [PMID: 37709511 DOI: 10.1136/rapm-2023-104858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 07/17/2023] [Indexed: 09/16/2023]
Affiliation(s)
- Victor M Silva-Ortiz
- Hospital Zambrano Hellion, San Pedro Garza Garcia, NLE, Mexico
- Latin American Pain Society, New York
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21
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Van Zundert J, Vanderdonckt M, Buyse K, Mestrum R, Mesotten D, Van Boxem K. Pulsed radiofrequency treatment of the Gasserian ganglion for trigeminal neuralgia: a retrospective study (PROGRESS). Reg Anesth Pain Med 2023:rapm-2022-104310. [PMID: 37429618 DOI: 10.1136/rapm-2022-104310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Accepted: 06/23/2023] [Indexed: 07/12/2023]
Affiliation(s)
- Jan Van Zundert
- Anesthesiology, Intensive Care, Emergency Medicine and Multidisciplinary Pain Center, Ziekenhuis Oost-Limburg, Genk, Belgium
- Department of Anesthesiology and Pain Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Matthias Vanderdonckt
- Department of Anesthesiology, Ziekenhuis Oost-Limburg, Genk, Belgium
- Department of Anesthesiology, University Hospitals Leuven, Leuven, Belgium
| | - Klaas Buyse
- Anesthesiology, Intensive Care, Emergency Medicine and Multidisciplinary Pain Center, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Roel Mestrum
- Anesthesiology, Intensive Care, Emergency Medicine and Multidisciplinary Pain Center, Ziekenhuis Oost-Limburg, Genk, Belgium
- Department of Anesthesiology, Intensive Care, Pain Medicine Heilig Hart Ziekenhuis, Tienen, Belgium
| | - Dieter Mesotten
- Department of Anesthesiology, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Koen Van Boxem
- Anesthesiology, Intensive Care, Emergency Medicine and Multidisciplinary Pain Center, Ziekenhuis Oost-Limburg, Genk, Belgium
- Department of Anesthesiology and Pain Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
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22
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Wang EJ, Dolomisiewicz E, Karri J, Tontisirin N, Cohen SP. Antimicrobial therapies for chronic pain (part 2): the prevention and treatment of chronic pain. Korean J Pain 2023; 36:299-315. [PMID: 37394273 DOI: 10.3344/kjp.23130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 06/15/2023] [Accepted: 06/20/2023] [Indexed: 07/04/2023] Open
Abstract
The discovery and development of antimicrobial therapies represents one of the most significant advancements in modern medicine. Although the primary therapeutic intent of antimicrobials is to eliminate their target pathogens, several antimicrobials have been shown to provide analgesia as a secondary benefit. Antimicrobials have demonstrated analgesic effects in conditions that involve dysbiosis or potential subclinical infection (e.g ., chronic low back pain with Modic type 1 changes; chronic prostatitis/chronic pelvic pain; irritable bowel syndrome; inflammatory bowel disease; functional gastrointestinal disorders/dyspepsia; myalgic encephalomyelitis/chronic fatigue syndrome), and might even prevent the chronification of pain after acute infections that are associated with excessive systemic inflammation (e.g ., post COVID-19 condition/long Covid, rheumatic fever). Clinical studies often assess the analgesic effects of antimicrobial therapies in an observational manner, without the ability to identify causative relationships, and significant gaps in the understanding remain regarding the analgesic potential of antimicrobials. Numerous interrelated patient-specific, antimicrobial-specific, and disease-specific factors altogether contribute to the perception and experience of pain, and each of these requires further study. Given worldwide concerns regarding antimicrobial resistance, antimicrobials must continue to be used judiciously and are unlikely to be repurposed as primary analgesic medications. However, when equipoise exists among several antimicrobial treatment options, the potential analgesic benefits of certain antimicrobial agents might be a valuable aspect to consider in clinical decision-making. This article (the second in a two-part series) aims to comprehensively review the evidence on the prevention and treatment of chronic pain using antimicrobial therapies and suggest a framework for future studies on this topic.
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Affiliation(s)
- Eric J Wang
- Department of Anesthesiology and Critical Care Medicine, Division of Pain Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Edward Dolomisiewicz
- Department of Physical Medicine and Rehabilitation, Walter Reed National Military Medical Center, Bethesda, MD, USA
- Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Jay Karri
- Departments of Orthopedic Surgery and Anesthesiology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Nuj Tontisirin
- Department of Anesthesiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Steven P Cohen
- Department of Anesthesiology and Critical Care Medicine, Division of Pain Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Physical Medicine and Rehabilitation, Walter Reed National Military Medical Center, Bethesda, MD, USA
- Departments of Physical Medicine & Rehabilitation, Neurology, and Psychiatry and Behavioral Sciences, Johns Hopkins University 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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23
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Wang EJ, Karri J, Tontisirin N, Cohen SP. Antimicrobial therapies for chronic pain (part 1): analgesic mechanisms. Korean J Pain 2023; 36:281-298. [PMID: 37394272 DOI: 10.3344/kjp.23129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 06/15/2023] [Accepted: 06/15/2023] [Indexed: 07/04/2023] Open
Abstract
There is increasing evidence that the relationship between chronic pain and infections is complex and intertwined. Bacterial and viral infections can cause pain through numerous mechanisms such as direct tissue damage and inflammation, the induction of excessive immunologic activity, and the development of peripheral or central sensitization. Treating infections might relieve pain by attenuating these processes, but a growing body of literature suggests that some antimicrobial therapies confer analgesic effects, including for nociceptive and neuropathic pain symptoms, and affective components of pain. The analgesic mechanisms of antimicrobials are indirect, but might be conceptualized into two broad categories: 1) the reduction of the infectious burden and associated pro-inflammatory processes; and 2) the inhibition of signaling processes (e.g., enzymatic and cytokine activity) necessary for nociception and maladaptive neuroplastic changes via off-target effects (unintended binding sites). For the former, there is evidence that symptoms of chronic low back pain (when associated with Modic type 1 changes), irritable bowel syndrome, inflammatory bowel disease, chronic pelvic pain, and functional dyspepsia might be improved after antibiotic treatment, though significant questions remain regarding specific regimens and dose, and which subpopulations are most likely to benefit. For the latter, there is evidence that several antimicrobial classes and medications exert analgesic effects independent of their reduction of infectious burden, and these include cephalosporins, ribavirin, chloroquine derivatives, rapalogues, minocycline, dapsone, and piscidin-1. This article aims to comprehensively review the existing literature for antimicrobial agents that have demonstrated analgesic efficacy in preclinical or clinical studies.
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Affiliation(s)
- Eric J Wang
- Department of Anesthesiology and Critical Care Medicine, Division of Pain Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jay Karri
- Departments of Orthopedic Surgery and Anesthesiology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Nuj Tontisirin
- Department of Anesthesiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Steven P Cohen
- Department of Anesthesiology and Critical Care Medicine, Division of Pain Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Physical Medicine and Rehabilitation, Walter Reed National Military Medical Center, Bethesda, MD, USA
- Departments of Physical Medicine & Rehabilitation, Neurology, and Psychiatry and Behavioral Sciences, Johns Hopkins University 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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Oh J, Park Y, Choi J, Jeon Y. Superior laryngeal nerve block for treatment of throat pain and cough following laryngeal herpes zoster: A case report. World J Clin Cases 2023; 11:4433-4437. [PMID: 37449242 PMCID: PMC10337000 DOI: 10.12998/wjcc.v11.i18.4433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 05/17/2023] [Accepted: 05/22/2023] [Indexed: 06/26/2023] Open
Abstract
BACKGROUND Herpes zoster is caused by reactivation of latent varicella-zoster virus infection within the sensory nerve ganglion of the spinal or cranial nerves. Laryngeal herpes zoster is rare and involves superior laryngeal nerve, which leads to several complications such as throat pain, and cough.
CASE SUMMARY Patient concerns: A 52-year old woman presented with a 70 d history of throat pain and a 67 d history of non-productive cough. Three days after onset of pain, she was diagnosed with laryngeal herpes zoster. Flexible nasolaryngoscopy revealed multiple white ulcerated lesions on the left hemi epiglottis and the left supraglottic area. She was prescribed with 750 mg famciclovir a day for 7 d, and 150 mg pregabalin, 100 mg tramadol and 10 mg nortriptyline a day for 67 d. However, despite of these medications, she complained of pain and persistent cough. Therefore, superior laryngeal nerve block under ultrasound guidance was performed. Three days after the intervention, the throat pain and cough disappeared. The patient remained symptom-free at 3 mo follow-up.
CONCLUSION A superior laryngeal nerve block can be an effective option for treatment of pain and cough following laryngeal herpes zoster.
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Affiliation(s)
- Jinyoung Oh
- Department of Anesthesiology and Pain Medicine, School of Medicine, Kyungpook National University, Daegu 41944, South Korea
| | - Youngje Park
- Department of Anesthesiology and Pain Medicine, Kyungpook National University Hospital, Daegu 41944, South Korea
| | - Jeongkyu Choi
- Department of Anesthesiology and Pain Medicine, Kyungpook National University Hospital, Daegu 41944, South Korea
| | - Younghoon Jeon
- Department of Anesthesiology and Pain Medicine, School of Dentistry, Kyungpook National University, Daegu 41944, South Korea
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Oliveira M, Reis-Pina P. [Chemotherapy-Induced Peripheral Neuropathic Pain and the Impact on the Quality of Life]. ACTA MEDICA PORT 2023; 36:440. [PMID: 37261915 DOI: 10.20344/amp.????] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Accepted: 03/14/2023] [Indexed: 06/03/2023]
Affiliation(s)
- Marta Oliveira
- Unidade de Saúde Familiar Cardilium. Agrupamento Centros de Saúde do Médio Tejo. Administração Regional de Saúde de Lisboa e Vale do Tejo. Torres Novas. Portugal
| | - Paulo Reis-Pina
- Casa de Saúde da Idanha. Sintra; Faculdade de Medicina da Universidade de Lisboa. Lisboa. Portugal
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Oliveira M, Reis-Pina P. [Chemotherapy-Induced Peripheral Neuropathic Pain and the Impact on the Quality of Life]. ACTA MEDICA PORT 2023; 36:440. [PMID: 37261915 DOI: 10.20344/amp.19883] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Accepted: 03/14/2023] [Indexed: 01/07/2024]
Affiliation(s)
- Marta Oliveira
- Unidade de Saúde Familiar Cardilium. Agrupamento Centros de Saúde do Médio Tejo. Administração Regional de Saúde de Lisboa e Vale do Tejo. Torres Novas. Portugal
| | - Paulo Reis-Pina
- Casa de Saúde da Idanha. Sintra; Faculdade de Medicina da Universidade de Lisboa. Lisboa. Portugal
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Zhou S, Pan Y, Zhang Y, Gu L, Ma L, Xu Q, Wang W, Sun J. Antisense oligodeoxynucleotides against dynamin-related protein 1 reduce remifentanil-induced hyperalgesia by modulating spinal N-methyl-D-aspartate receptor expression in rats. Korean J Pain 2023:kjp.22398. [PMID: 37183652 DOI: 10.3344/kjp.22398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 02/19/2023] [Accepted: 04/02/2023] [Indexed: 05/16/2023] Open
Abstract
Background Spinal N-methyl-D-aspartate (NMDA) receptor activation is attributed to remifentanil-induced hyperalgesia (RIH). However, the specific mechanism and subsequent treatment is still unknown. Previous studies have shown that the dynamin-related protein 1 (DRP1)-mitochondria-reactive oxygen species (ROS) pathway plays an important role in neuropathic pain. This study examined whether antisense oligodeoxynucleotides against DRP1 (AS-DRP1) could reverse RIH. Methods The authors first measured changes in paw withdrawal mechanical threshold (PWMT) and paw withdrawal thermal latency (PWTL) at 24 hours before remifentanil infusion and 4, 8, 24, and 48 hours after infusion. The expression levels of DRP1 and NR2B were measured after behavioral testing using Western blotting. In addition, DRP1 expression was knocked down by intrathecal administration of AS-DRP1 to investigate the effects of DRP1 on RIH. The behavioral testing, the expression levels of spinal DRP1 and NR2B, and dorsal mitochondrial superoxide were measured. Changes in mitochondrial morphology were assessed using electron microscopy. Results After remifentanil exposure, upregulation of spinal DRP1 and NR2B was observed along with a reduction in PWMT and PWTL. In addition, AS-DRP1 improved RIH-induced PWTL and PWMT (P < 0.001 and P < 0.001) and reduced remifentanil-mediated enhancement of spinal DRP1 and NR2B expression (P = 0.020 and P = 0.022). More importantly, AS-DRP1 reversed RIH-induced mitochondrial fission (P = 0.020) and mitochondrial superoxide upregulation (P = 0.031). Conclusions These results indicate that AS-DRP1 could modulate NMDA receptor expression to prevent RIH through the DRP1-mitochondria-ROS pathway.
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Affiliation(s)
- Songyi Zhou
- Department of Anesthesiology, 1st Affiliated Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Yizhao Pan
- Department of Anesthesiology, 1st Affiliated Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Yan Zhang
- Operative Room Nursing, 1st Affiliated Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Lijun Gu
- Department of Anesthesiology, 1st Affiliated Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Leikai Ma
- Department of Anesthesiology, 1st Affiliated Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Qingqing Xu
- Operative Room Nursing, 1st Affiliated Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Weijian Wang
- Department of Anesthesiology, 1st Affiliated Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Jiehao Sun
- Department of Anesthesiology, 1st Affiliated Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
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Vanneste T, Belba A, Kallewaard JW, van Kuijk SMJ, Gelissen M, Emans P, Bellemans J, Smeets K, Terwiel C, Van Boxem K, Sommer M, Van Zundert J. Comparison of cooled versus conventional radiofrequency treatment of the genicular nerves for chronic knee pain: a multicenter non-inferiority randomized pilot trial (COCOGEN trial). Reg Anesth Pain Med 2023; 48:197-204. [PMID: 36653065 PMCID: PMC10086476 DOI: 10.1136/rapm-2022-104054] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 01/02/2023] [Indexed: 01/19/2023]
Abstract
BACKGROUND Radiofrequency (RF) treatment of the genicular nerves has the potential to reduce chronic knee pain due to osteoarthritis or persistent postsurgical pain, however, a direct comparison between the two main modalities used, conventional and cooled, is lacking. METHODS This double blind, non-inferiority, pilot, randomized controlled trial compared the effects of cooled and conventional RF in chronic knee pain patients suffering from osteoarthritis or persistent postsurgical pain after total knee arthroplasty. Patients were randomized following a 1:1 rate. The primary outcome was the proportion of patients with ≥50% pain reduction at 3 months postintervention. Other outcomes were knee pain, functionality, quality of life, emotional health, and adverse events up to 6 months postintervention. Conventional RF treatment was tested for non-inferiority to cooled in reducing knee pain at 3 months follow-up. RESULTS Forty-nine of 70 patients were included, of which 47 completed a 3-month follow-up. The primary outcome was achieved in 4 of 23 patients treated with conventional RF (17%) vs in 8 of 24 with cooled (33%) (p=0,21). Results from the non-inferiority comparison were inconclusive in relation to the non-inferiority margin. There was no statistically significant difference between secondary outcomes. There were no serious adverse events. CONCLUSIONS Both conventional and cooled RF treatment reduced pain in the osteoarthritis and persistent postsurgical pain population. This pilot study did not demonstrate statistically significant differences in the proportion of patients experiencing ≥50% pain reduction between techniques. The non-inferiority analysis was inconclusive. These results warrant further research. TRIAL REGISTRATION NUMBER NCT03865849.
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Affiliation(s)
- Thibaut Vanneste
- Department of Anesthesiology, Intensive Care Medicine, Emergency Medicine and Multidisciplinary Pain Center, Ziekenhuis Oost-Limburg, Genk, Belgium
- Department of Anesthesiology and Pain Medicine, Maastricht UMC+, Maastricht, The Netherlands
| | - Amy Belba
- Department of Anesthesiology, Intensive Care Medicine, Emergency Medicine and Multidisciplinary Pain Center, Ziekenhuis Oost-Limburg, Genk, Belgium
- Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | | | - Sander M J van Kuijk
- Department of Clinical Epidemiology & Medical Technology Assessment, Maastricht UMC+, Maastricht, The Netherlands
| | - Marloes Gelissen
- Department of Anesthesiology and Pain Medicine, Maastricht UMC+, Maastricht, The Netherlands
| | - Peter Emans
- Department of Orthopaedic Surgery, CAPHRI School for Public Health and Primary Care, Maastricht UMC+, Maastricht, The Netherlands
| | - Johan Bellemans
- Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
- Department of Orthopedic Surgery, Ziekenhuis Oost-Limburg, Genk, Belgium
- GRIT Belgian sports clinic, Leuven, Belgium
| | - Kristof Smeets
- Department of Rehabilitation Sciences and Physiotherapy, BIOMED REVAL Rehabilitation Research Institute, Hasselt University, Hasselt, Belgium
| | - Chris Terwiel
- Department of Anesthesiology and Pain Medicine, Rijnstate, Arnhem, The Netherlands
| | - Koen Van Boxem
- Department of Anesthesiology, Intensive Care Medicine, Emergency Medicine and Multidisciplinary Pain Center, Ziekenhuis Oost-Limburg, Genk, Belgium
- Department of Anesthesiology and Pain Medicine, Maastricht UMC+, Maastricht, The Netherlands
| | - Micha Sommer
- Department of Anesthesiology and Pain Medicine, Maastricht UMC+, Maastricht, The Netherlands
| | - Jan Van Zundert
- Department of Anesthesiology, Intensive Care Medicine, Emergency Medicine and Multidisciplinary Pain Center, Ziekenhuis Oost-Limburg, Genk, Belgium
- Department of Anesthesiology and Pain Medicine, Maastricht UMC+, Maastricht, The Netherlands
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Zinboonyahgoon N, Luansritisakul C. Neuropathic pain feature in cancer-induced bone pain: does it matter? a prospective observational study. Korean J Pain 2023; 36:253-267. [PMID: 36973971 PMCID: PMC10043784 DOI: 10.3344/kjp.22392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 02/13/2023] [Accepted: 02/25/2023] [Indexed: 03/29/2023] Open
Abstract
Background Cancer-induced bone pain (CIBP) is considered to have both nociceptive and neuropathic components. However, the prevalence, risk factors, and impact of the neuropathic components are yet poorly understood. Methods We estimate the prevalence of neuropathic pain (NP) features in patients with CIBP at a tertiary care pain clinic setting using the Douleur Neuropathique 4 questionnaire and evaluate their associated factors and their impact after 4 weeks of treatment using the Brief Pain Inventory questionnaire and the Edmonton Symptom Assessment System. Results A total of 133 patients were recruited. The estimated prevalence of NP was 30.8% (95% confidence interval: 23.6%-39.1%). Initially, the patients with NP had significantly higher average pain scores (6.00 vs. 5.05, P = 0.006), higher total interference scores (5.84 vs. 4.89, P = 0.033), and symptom distress scores (35.88 vs. 26.52, P = 0.002). After 4 weeks of treatment, patients in both groups reported significantly decreased pain intensity and improved quality of life. However, the patients with NP still reported significantly higher average pain (4.61 vs. 3.58, P = 0.048), trending toward higher total interference scores (3.52 vs. 2.99, P = 0.426), and symptom distress scores (23.30 vs. 20.77, P = 0.524). From multivariate analysis, the independent risk factors for NP were younger age, pain in the extremities, and higher average pain scores. Conclusions NP are common in patients with CIBP. These conditions negatively affect pain intensity and the patient's quality of life before and after treatment.
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Affiliation(s)
- Nantthasorn Zinboonyahgoon
- Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Choopong Luansritisakul
- Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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30
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Kim BR, Yoon SH, Lee HJ. Practical strategies for the prevention and management of chronic postsurgical pain. Korean J Pain 2023; 36:149-162. [PMID: 36973967 PMCID: PMC10043790 DOI: 10.3344/kjp.23080] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 03/17/2023] [Accepted: 03/18/2023] [Indexed: 03/29/2023] Open
Abstract
Chronic postsurgical pain (CPSP) is a multifactorial condition that affects a significant proportion of patients undergoing surgery. The prevention and management of CPSP require the identification of preoperative risk factors to screen high-risk patients and establish appropriate perioperative pain management plans to prevent its development. Active postoperative pain management should be provided to prevent CPSP in patients with severe pain following surgery. These tasks have become important for perioperative team members in the management of CPSP. This review article provides a comprehensive overview of the latest research on the role of perioperative team members in preventing and managing CPSP. Additionally, it highlights practical strategies that can be employed in clinical practice, covering the definition and risk factors for CPSP, including preoperative, intraoperative, and postoperative factors, as well as a risk prediction model. The article also explores various treatments for CPSP, as well as preventive measures, including preemptive analgesia, regional anesthesia, pharmacological interventions, psychoeducational support, and surgical technique modification. This article emphasizes the importance of a comprehensive perioperative pain management plan that includes multidisciplinary interventions, using the transitional pain service as an example. By adopting a multidisciplinary and collaborative approach, perioperative team members can improve patient outcomes, enhance patient satisfaction, and reduce healthcare costs. However, further research is necessary to establish targeted interventions to effectively prevent and manage CPSP.
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Affiliation(s)
- Bo Rim Kim
- Department of Anesthesiology and Pain Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Soo-Hyuk Yoon
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Korea
| | - Ho-Jin Lee
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Korea
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul, Korea
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31
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Cardona JJ, Chaiyamoon A, Carrera A, Reina F, Iwanaga J, Tubbs RS. Penetration of the facial nerve by the posterior auricular artery: case report, comprehensive review and clinical-surgical applications. Anat Sci Int 2023. [PMID: 36879134 DOI: 10.1007/s12565-023-00708-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Accepted: 02/22/2023] [Indexed: 03/08/2023]
Abstract
Anatomical variations between the facial nerve and adjacent arteries are rare. However, knowledge of such anatomical variations is important to the surgeon who operates on or near the facial nerve. Herein, we report an unusual finding between the extracranial part of the facial nerve and a nearby artery. During routine dissection of the right facial nerve trunk, the posterior auricular artery was found to pierce the nerve effectively forming a nerve loop. The nerve was pierced by the artery soon after its exit from the stylomastoid foramen. This case is detailed and a review on this topic presented, specifically identifying previously reported studies describing this or similar variations, and the relationship between the posterior auricular artery and facial nerve trunk in general. Piercing of the facial nerve trunk by the posterior auricular artery appears to be rare. However, such a relationship should be known by the clinician who treats patients with pathologies of the facial nerve trunk. To our knowledge, this is the first report of this variation in an adult. Due to such rarity, this case is of archival value for those who might describe it or similar cases in the future.
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Mansano AM, Frederico TN, Valentin REB, Carmona MJC, Ashmawi HA. Percutaneous Radiofrequency Ablation for Trigeminal Neuralgia Management: A Randomized, Double-Blinded, Sham-Controlled Clinical Trial. Pain Med 2023; 24:234-243. [PMID: 36029256 DOI: 10.1093/pm/pnac132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 08/19/2022] [Accepted: 08/22/2022] [Indexed: 11/13/2022]
Abstract
Trigeminal neuralgia, considered by many the worst pain that humankind can experience, has been called "the suicide disease." Neuroablative procedures are good options when conservative treatment fails to promote pain relief or in those whose side effects are unbearable. The objective was to compare the effectiveness and safety of trigeminal percutaneous radiofrequency ablation in classical refractory trigeminal neuralgia in a prospective, randomized, double-blind, sham-controlled clinical trial. We included 30 consecutive patients with classical trigeminal neuralgia who had failed to respond to drug treatment. The patients were randomly assigned into two groups: a thermal radiofrequency and a sham group. The thermal radiofrequency group were submitted to a 75°C lesion for 60 seconds after proper sensory and motor stimulation. All steps were carried out in the sham group except the thermal lesion. Patients were evaluated using the Numerical Rating Scale (NRS), the 36-Item Short-Form Health Survey questionnaire, and anticonvulsant dose. After 1 month, the mean NRS score decreased from 9.2 to 0.7 in the radiofrequency group and from 8.9 to 5.8 in the sham group. This significant reduction was measurable starting at day one after the procedure and remained significant throughout the first month. Changing groups was allowed after one month, after which the pain reduction was similar between the two groups. Percutaneous trigeminal radiofrequency ablation results in statistically and clinically significant greater pain relief than the sham procedure after 1 month of follow-up. These results support using radiofrequency nerve ablation as a treatment for refractory trigeminal neuralgia.
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Affiliation(s)
- André Marques Mansano
- Anesthesiology Department, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Thiago Nouer Frederico
- Interventional Pain Management, Hospita Israelita Albert Einstein, São Paulo, SP, Brazil
| | | | | | - Hazem Adel Ashmawi
- Anesthesiology Department, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
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Meaadi J, Obara I, Eldabe S, Nazar H. The safety and efficacy of gabapentinoids in the management of neuropathic pain: a systematic review with meta-analysis of randomised controlled trials. Int J Clin Pharm 2023:10.1007/s11096-022-01528-y. [PMID: 36848024 DOI: 10.1007/s11096-022-01528-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 12/01/2022] [Indexed: 03/01/2023]
Abstract
BACKGROUND There are increasing concerns regarding the abusive potential of gabapentinoids putting at risk patients with neuropathic pain requiring long-term pain management. The evidence to support this is rather inconcusive. AIM This systematic review aimed to evaluate the safety and efficacy of gabapentinoids in the management of neuropathic pain with a focus on randomised controlled trials (RCTs) and categorising the side effects according to the body systems they were affecting. METHOD Searches were conducted in MEDLINE (PubMed), EMBASE, Web of Science, PsycoINFO, and CINAHL (EBSCO), and included RCTs to identify and critically appraise studies investigating safety and therapeutic effects of gabapentionoids in adults with neuropathic pain. Data extraction was conducted using an established Cochrane form and the risk-of-bias tool was used in the assessment of quality. RESULTS 50 studies (12,398 participants) were included. The majority of adverse events pertained to the nervous system (7 effects) or psychiatric (3 effects) disorders. There were more adverse effects reported with pregabalin (36 effects) than with gabapentin (22 effects). Six pregabalin studies reported euphoria as a side effect, while no studies reported euphoria with gabapentin. This was the only side effect that may correlate with addictive potential. Gabapentioids were reported to significantly reduce pain compared to placebo. CONCLUSION Despite RCTs documenting the adverse events of gabapentionoids on the nervous system, there was no evidence of gabapentinoid use leading to addiction, suggesting an urgent need to design studies investigating their abusive potential.
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Affiliation(s)
- Jawza Meaadi
- School of Pharmacy, Faculty of Medical Sciences, Newcastle University, King George VI Building, Newcastle-Upon-Tyne, NE1 7RU, UK.,Translational and Clinical Research Institute, Newcastle University, Newcastle-Upon-Tyne, UK.,King Saud Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Ilona Obara
- School of Pharmacy, Faculty of Medical Sciences, Newcastle University, King George VI Building, Newcastle-Upon-Tyne, NE1 7RU, UK. .,Translational and Clinical Research Institute, Newcastle University, Newcastle-Upon-Tyne, UK.
| | - Sam Eldabe
- Department of Pain and Anaesthesia, James Cook Hospital, Middlesbrough, UK
| | - Hamde Nazar
- School of Pharmacy, Faculty of Medical Sciences, Newcastle University, King George VI Building, Newcastle-Upon-Tyne, NE1 7RU, UK.,Population Health Sciences Institute, Newcastle University, Newcastle-Upon-Tyne, UK
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Hosseini M, Asarzadegan F, Shafiee E, Alijanpour S. Trigeminal neuralgia: IncobotulinumtoxinA (Xeomin), can it decrease the pharmacological intervention? (A case series). Caspian J Intern Med 2023; 14:376-379. [PMID: 37223298 PMCID: PMC10201132 DOI: 10.22088/cjim.14.2.376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 12/18/2021] [Accepted: 12/25/2021] [Indexed: 05/25/2023]
Abstract
Background Trigeminal neuralgia is one of the most disabling facial pain syndromes. In recent years' new therapeutic strategy, incobotulinumtoxin A has emerged. The aim of the current study was to determine the time and duration of pain in 3 cases with pharmacological treatment and incobotulinumtoxin A. Case presentation In three patients with different onsets, trigeminal neuralgia was diagnosed. Pain severity was assessed by the visual analogue scale. Patient demographics and clinical data were filled in a checklist. They were females with age ranging from 39 to 49 years. Two patients had normal MRI and one patient had no any recent MRI. One center and specialist injection Xeomin 50 units for one time. Despite long time oral treatment, their symptoms had no significant improvement, but after incobotulinumtoxin A injection, pain frequency, severity and duration decreased in patients. Conclusion Result showed that the frequency, severity and duration of pain attacks was efficiently decreased by incobotulinumtoxin A with low side-effects. Its complication and side-effect should be considered in the future.
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Affiliation(s)
- Meghdad Hosseini
- Department of Neurology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farhad Asarzadegan
- Department of Neurology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Erfan Shafiee
- Department of Neurology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Shayan Alijanpour
- Students Scientific Research Center, School of Nursing and Midwifery, Tehran University of Medical Science, Tehran, Iran
- Research and Planning Unite, Pre-hospital Emergency Organization and Emergency Medical Service Center, Babol University of Medical Sciences, Babol, Iran
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Kim SH. Current scenario and future applicability of antivirals against herpes zoster. Korean J Pain 2023; 36:4-10. [PMID: 36573010 PMCID: PMC9812693 DOI: 10.3344/kjp.22391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 12/14/2022] [Accepted: 12/15/2022] [Indexed: 12/28/2022] Open
Abstract
Herpes zoster (HZ) is a common disease in the aging population and immunocompromised individuals, with a lifetime risk of 20%-30% that increases with age. HZ is caused by reactivation of the varicella-zoster virus (VZV), which remains latent in the spinal dorsal root ganglia and cranial sensory ganglia after resolution of the primary VZV infection. The main focus of HZ management is rapid recovery from VZV infection as well as the reduction and prevention of zoster-associated pain (ZAP) and postherpetic neuralgia (PHN). The use of antivirals against VZV is essential in the treatment of HZ. However, limited antivirals are only licensed clinically for the treatment of HZ, including acyclovir, valacyclovir, famciclovir, brivudine, and amenamevir. Fortunately, some new antivirals against different types of Herpesviridae have been investigated and suggested as novel drugs against VZV. Therefore, this review focuses on discussing the difference in efficacy and safety in the currently licensed antivirals for the treatment of HZ, the applicability of future novel antivirals against VZV, and the preventive or therapeutic effects of these antivirals on ZAP or PHN.
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Affiliation(s)
- Sang Hun Kim
- Department of Anesthesiology and Pain Medicine, Chosun University Hospital, Gwangju, Korea,Department of Anesthesiology and Pain Medicine, School of Medicine, Chosun University, Gwangju, Korea,Correspondence: Sang Hun Kim Department of Anesthesiology and Pain Medicine, Chosun University Hospital, 365 Pilmun-daero, Dong-gu, Gwangju 61453, Korea, Tel: +82-62-220-3223, Fax: +82-62-223-2333, E-mail:
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Teuschl Y, Bancher C, Dachenhausen A, Matz K, Pinter MM. Botulinum Toxin-A for the Treatment of Neuropathic Pain after Decompressive Craniotomy in Stroke: Two Cases. Case Rep Neurol 2023; 15:192-198. [PMID: 37901125 PMCID: PMC10601619 DOI: 10.1159/000532096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 07/17/2023] [Indexed: 10/31/2023] Open
Abstract
Botulinum toxin-A (BoNT-A) is recommended as third-line off-label treatment for the management of neuropathic pain. BoNT-A has been reported as treatment for different neuropathic pain conditions; however, not for neuropathic pain after decompressive craniotomy for stroke. The aim of this retrospective case series is to provide information on safety, the effect, and the application method of BoNT-A in clinical practice for the treatment of neuropathic pain after trepanation. This case series describes 2 patients treated in 2021 at a BoNT outpatient clinic for chronic neuropathic pain at the incisional site after decompressive craniotomy for stroke who were resistant to pain medication. Cases were a 48-year-old woman and a 63-year-old man suffering from chronic neuropathic pain since 3 and 6 years, respectively. They were treated regularly with BoNT-A with a total dose of 100 mouse units of incobotulinumtoxin-A injected into peri-incisional sites of the scalp. Both patients reported subjective decrease in pain frequency (40% and 60%), in pain intensity (60% and 90%), and an increase of quality of life (80%). BoNT-A should be further investigated as treatment for neuropathic pain - especially in underreported conditions such as neuropathic pain after craniotomy in stroke.
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Affiliation(s)
- Yvonne Teuschl
- Department for Clinical Neurosciences and Preventive Medicine, University for Continuing Education Krems, Krems, Austria
| | - Christian Bancher
- Department of Neurology, Landesklinikum Horn-Allentsteig, Horn, Austria
| | - Alexandra Dachenhausen
- Department for Clinical Neurosciences and Preventive Medicine, University for Continuing Education Krems, Krems, Austria
| | - Karl Matz
- Department for Clinical Neurosciences and Preventive Medicine, University for Continuing Education Krems, Krems, Austria
- Department of Neurology, Landesklinikum Mödling, Mödling, Austria
| | - Michaela M. Pinter
- Department for Clinical Neurosciences and Preventive Medicine, University for Continuing Education Krems, Krems, Austria
- Department of Neurology, Landesklinikum Horn-Allentsteig, Horn, Austria
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Semita IN, Utomo DN, Suroto H, Sudiana IK, Gandi P. The mechanism of human neural stem cell secretomes improves neuropathic pain and locomotor function in spinal cord injury rat models: through antioxidant, anti-inflammatory, anti-matrix degradation, and neurotrophic activities. Korean J Pain 2023; 36:72-83. [PMID: 36549874 PMCID: PMC9812698 DOI: 10.3344/kjp.22279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 11/09/2022] [Accepted: 11/13/2022] [Indexed: 12/24/2022] Open
Abstract
Background Globally, spinal cord injury (SCI) results in a big burden, including 90% suffering permanent disability, and 60%-69% experiencing neuropathic pain. The main causes are oxidative stress, inflammation, and degeneration. The efficacy of the stem cell secretome is promising, but the role of human neural stem cell (HNSC)-secretome in neuropathic pain is unclear. This study evaluated how the mechanism of HNSC-secretome improves neuropathic pain and locomotor function in SCI rat models through antioxidant, anti-inflammatory, anti-matrix degradation, and neurotrophic activities. Methods A proper experimental study investigated 15 Rattus norvegicus divided into normal, control, and treatment groups (30 μL HNSC-secretome, intrathecal in the level of T10, three days post-traumatic SCI). Twenty-eight days post-injury, specimens were collected, and matrix metalloproteinase (MMP)-9, F2-Isoprostanes, tumor necrosis factor (TNF)-α, transforming growth factor (TGF)-β, and brain derived neurotrophic factor (BDNF) were analyzed. Locomotor recovery was evaluated via Basso, Beattie, and Bresnahan scores. Neuropathic pain was evaluated using the Rat Grimace Scale. Results The HNSC-secretome could improve locomotor recovery and neuropathic pain, decrease F2-Isoprostane (antioxidant), decrease MMP-9 and TNF-α (anti-inflammatory), as well as modulate TGF-β and BDNF (neurotrophic factor). Moreover, HNSC-secretomes maintain the extracellular matrix of SCI by reducing the matrix degradation effect of MMP-9 and increasing the collagen formation effect of TGF-β as a resistor of glial scar formation. Conclusions The present study demonstrated the mechanism of HNSC-secretome in improving neuropathic pain and locomotor function in SCI through antioxidant, anti-inflammatory, anti-matrix degradation, and neurotrophic activities.
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Affiliation(s)
- I Nyoman Semita
- Doctoral Program of Medical Science, Faculty of Medicine, Airlangga University, Surabaya, Indonesia,Department of Orthopaedic, Faculty of Medicine, University of Jember, Jember, Indonesia
| | - Dwikora Novembri Utomo
- Department of Orthopaedic, Faculty of Medicine, Airlangga University, Surabaya, Indonesia,Correspondence: Dwikora Novembri Utomo Department of Orthopaedic, Faculty of Medicine, Airlangga University, Jl. Manyar Tirtosari IV/7, Surabaya, East Java, Indonesia, Tel: +628123036236, Fax: +62315020406, E-mail:
| | - Heri Suroto
- Department of Orthopaedic, Faculty of Medicine, Airlangga University, Surabaya, Indonesia
| | - I Ketut Sudiana
- Department of Anatomic Pathology, Faculty of Medicine, Airlangga University, Surabaya, Indonesia
| | - Parama Gandi
- Departement of Cardiology, Faculty of Medicine, Airlangga University, Surabaya, Indonesia
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Crul TC, Post MWM, Visser-Meily JMA, Stolwijk-Swüste JM. Prevalence and Determinants of Pain in Spinal Cord Injury During Initial Inpatient Rehabilitation: Data From the Dutch Spinal Cord Injury Database. Arch Phys Med Rehabil 2023; 104:74-82. [PMID: 35914561 DOI: 10.1016/j.apmr.2022.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 07/15/2022] [Accepted: 07/15/2022] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To describe the prevalence and characteristics of spinal cord injury (SCI)-related pain during initial inpatient rehabilitation and to investigate relationships with demographic and lesion characteristics. DESIGN Cohort during inpatient rehabilitation. SETTING Eight specialized SCI rehabilitation centers in the Netherlands. PARTICIPANTS Patients with newly acquired SCI admitted for inpatient rehabilitation between November 2013 and August 2019 (N=1432). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Presence of pain at admission and discharge. Logistic regression analyses were used to study the prevalence of pain related to sex, age, etiology, completeness, and level of injury. RESULTS Data from 1432 patients were available. Of these patients 64.6% were male, mean age was 56.8 years, 59.9% had a nontraumatic SCI, 63.9% were classified as American Spinal Cord Injury Association Impairment Scale (AIS) D and 56.5% had paraplegia. Prevalence of pain was 61.2% at admission (40.6% nociceptive pain [NocP], 30.2% neuropathic pain [NeuP], 5.4% other pain) and 51.5% at discharge (26.0% NocP, 31.4% NeuP, 5.7% other pain). Having NocP at admission was associated with traumatic SCI. AIS B had a lower risk of NocP than AIS D at admission. Having NocP at discharge was associated with female sex and traumatic SCI. AIS C had a lower risk of NocP at discharge than AIS D. Having NeuP at admission was associated with female sex. Having NeuP at discharge was associated with female sex, age younger than 65 years vs age older than 75 years and tetraplegia. CONCLUSIONS SCI-related pain is highly prevalent during inpatient rehabilitation. Prevalence of NocP decreased during inpatient rehabilitation, and prevalence of NeuP stayed the same. Different patient and lesion characteristics were related to the presence of SCI-related pain. Healthcare professionals should be aware of these differences in screening patients on presence and development of pain during inpatient rehabilitation.
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Affiliation(s)
- Tim C Crul
- Centre of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Centre, University Medical Centre Utrecht, Utrecht; De Hoogstraat Rehabilitation, Utrecht
| | - Marcel W M Post
- Centre of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Centre, University Medical Centre Utrecht, Utrecht; De Hoogstraat Rehabilitation, Utrecht; University of Groningen, University Medical Centre Groningen, Centre for Rehabilitation, Groningen
| | - Johanna M A Visser-Meily
- Centre of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Centre, University Medical Centre Utrecht, Utrecht; De Hoogstraat Rehabilitation, Utrecht; Department of Rehabilitation, Physical Therapy Science, and Sports, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht
| | - Janneke M Stolwijk-Swüste
- Centre of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Centre, University Medical Centre Utrecht, Utrecht; De Hoogstraat Rehabilitation, Utrecht; Department of Spinal Cord Injury and Orthopedics, De Hoogstraat Rehabilitation, Utrecht, the Netherlands.
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Wang Q, #, Zhang Y, #, Du Q, Zhao X, Wang W, Zhai Q, Xiang M. SKF96365 impedes spinal glutamatergic transmission-mediated neuropathic allodynia. Korean J Physiol Pharmacol 2023; 27:39-48. [PMID: 36575932 PMCID: PMC9806642 DOI: 10.4196/kjpp.2023.27.1.39] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 08/18/2022] [Accepted: 09/08/2022] [Indexed: 12/29/2022]
Abstract
Spinal nerve injury causes mechanical allodynia and structural imbalance of neurotransmission, which were typically associated with calcium overload. Store-operated calcium entry (SOCE) is considered crucial elements-mediating intracellular calcium homeostasis, ion channel activity, and synaptic plasticity. However, the underlying mechanism of SOCE in mediating neuronal transmitter release and synaptic transmission remains ambiguous in neuropathic pain. Neuropathic rats were operated by spinal nerve ligations. Neurotransmissions were assessed by whole-cell recording in substantia gelatinosa. Immunofluorescence staining of STIM1 with neuronal and glial biomarkers in the spinal dorsal horn. The endoplasmic reticulum stress level was estimated from qRT-PCR. Intrathecal injection of SOCE antagonist SKF96365 dose-dependently alleviated mechanical allodynia in ipsilateral hind paws of neuropathic rats with ED50 of 18 μg. Immunofluorescence staining demonstrated that STIM1 was specifically and significantly expressed in neurons but not astrocytes and microglia in the spinal dorsal horn. Bath application of SKF96365 inhibited enhanced miniature excitatory postsynaptic currents in a dosage-dependent manner without affecting miniature inhibitory postsynaptic currents. Mal-adaption of SOCE was commonly related to endoplasmic reticulum (ER) stress in the central nervous system. SKF96365 markedly suppressed ER stress levels by alleviating mRNA expression of C/EBP homologous protein and heat shock protein 70 in neuropathic rats. Our findings suggested that nerve injury might promote SOCE-mediated calcium levels, resulting in long-term imbalance of spinal synaptic transmission and behavioral sensitization, SKF96365 produces antinociception by alleviating glutamatergic transmission and ER stress. This work demonstrated the involvement of SOCE in neuropathic pain, implying that SOCE might be a potential target for pain management.
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Affiliation(s)
- Qiru Wang
- Department of Pharmacy, Fudan University Shanghai Cancer Center, Minhang Branch, Shanghai 200240, China
| | - #
- Department of Pharmacy, Fudan University Shanghai Cancer Center, Minhang Branch, Shanghai 200240, China
| | - Yang Zhang
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai 200240, China
| | - #
- Department of Pharmacy, Fudan University Shanghai Cancer Center, Minhang Branch, Shanghai 200240, China
| | - Qiong Du
- Department of Pharmacy, Fudan University Shanghai Cancer Center, Minhang Branch, Shanghai 200240, China
| | - Xinjie Zhao
- Department of Pharmacy, Fudan University Shanghai Cancer Center, Minhang Branch, Shanghai 200240, China
| | - Wei Wang
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai 200240, China,Correspondence Ming Xiang, E-mail: , Qing Zhai, E-mail: , Wei Wang, E-mail:
| | - Qing Zhai
- Department of Pharmacy, Fudan University Shanghai Cancer Center, Minhang Branch, Shanghai 200240, China,Correspondence Ming Xiang, E-mail: , Qing Zhai, E-mail: , Wei Wang, E-mail:
| | - Ming Xiang
- Department of Pharmacy, Fudan University Shanghai Cancer Center, Minhang Branch, Shanghai 200240, China,Correspondence Ming Xiang, E-mail: , Qing Zhai, E-mail: , Wei Wang, E-mail:
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Mazerolle M, Babaei-Ghazani A, Boudier-Revéret M, Chang MC. A small painful neuroma of the transverse cervical nerve treated with pulsed radiofrequency: A case report. J Back Musculoskelet Rehabil 2022; 36:767-771. [PMID: 36565098 DOI: 10.3233/bmr-220114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Neck pain is a common complaint seen amongst patients from all ages. When common causes of neck pain have been ruled out, it is important to investigate further. A careful physical exam can help identify the painful structures. An ultrasound of the area can also be helpful to identify possible structures involved. Neuromas can be treated with oral medications as well as more invasive techniques, such as pulsed radiofrequency (PRF). CASE DESCRIPTION In this case report, we discuss a 67-year-old female who presented with left anterior neck pain after developing a cervical mass who was later diagnosed as non-Hodgkin lymphoma. A small neuroma of the left transverse cervical nerve was found on ultrasound and ultimately was treated with PRF with a complete resolution of her symptoms at two months follow-up. CONCLUSION PRF seems to be a useful tool for controlling neuropathic pain caused by a neuroma.
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Affiliation(s)
- Mylène Mazerolle
- Department of Physical Medicine and Rehabilitation, University of Montreal Health Center, Montreal, Canada
| | - Arash Babaei-Ghazani
- Department of Physical Medicine and Rehabilitation, University of Montreal Health Center, Montreal, Canada.,Neuromusculoskeletal Research Center, Department of Physical Medicine and Rehabilitation, Iran University of Medical Sciences, Tehran, Iran
| | - Mathieu Boudier-Revéret
- Department of Physical Medicine and Rehabilitation, University of Montreal Health Center, Montreal, Canada
| | - Min Cheol Chang
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Namku, Taegu, Korea
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41
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Lu Z, Fu L, Fan X. Spinal cord stimulation for the treatment of neuropathic pain associated with syringomyelia. Asian J Surg 2022; 45:2936-2937. [PMID: 35773104 DOI: 10.1016/j.asjsur.2022.06.111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 06/16/2022] [Indexed: 12/15/2022] Open
Affiliation(s)
- Zhongyuan Lu
- Department of Pain Management, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Lijun Fu
- Department of Pain Management, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Xiaochong Fan
- Department of Pain Management, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China.
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Edamura T, Sumitani M, Hayakawa K, Inoue R, Abe H, Tsuchida R, Chikuda H, Ogata T, Kurano M, Aoki J, Yatomi Y, Uchida K. Different Profiles of the Triad of Lysophosphatidylcholine, Lysophosphatidic Acid, and Autotaxin in Patients with Neuropathic Pain Diseases: a Preliminary Observational Study. Pain Ther 2022. [PMID: 36205847 DOI: 10.1007/s40122-022-00445-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 09/22/2022] [Indexed: 10/10/2022] Open
Abstract
The mechanisms underlying neuropathic pain remain unclear. Lysophosphatidic acid (LPA) is a bioactive phospholipid derived mainly from lysophosphatidylcholine (LPC) by extracellular autotaxin (ATX), and has attracted attention as a candidate biomarker of neuropathic pain. We aimed to investigate the levels of LPA, LPC, and ATX in patients with lumbar spinal canal stenosis (LSCS) or other neuropathic pain diseases, and to distinguish the underlying mechanism of LSCS from other neuropathic pain conditions. Furthermore, the levels of phosphorylated neurofilament heavy chain (pNF-H), an objective surrogate marker of axonal damage, were also measured. Cerebrospinal fluid (CSF) samples were obtained from 56 patients with LSCS (n = 31) and various etiologies other than LSCS (n = 25). Patients with LSCS complained of pain intensity comparable to that of patients without LSCS. The LPA levels were significantly higher in patients with LSCS than in non-LSCS patients, while the ATX levels were significantly lower. However, the differences in LPC and pNF-H levels between the two patient groups were not significant. The LPA/LPC ratio was significantly higher in the LSCS group. Notably, the difference in LPA between the two groups diminished in the analysis of covariance (ANCOVA) with ATX as a covariate. Thus, it helped to reveal that LPA synthesis in patients with LSCS depends more efficiently on ATX than in non-LSCS neuropathic pain patients with other etiologies. Our findings further suggest that the triad of LPA, LPC, and ATX in LSCS may contribute to the development and maintenance of neuropathic pain in a manner different from non-LSCS neuropathic conditions.
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Bu H, Jiao P, Fan X, Gao Y, Zhang L, Guo H. The role of botulinum toxin type A related axon transport in neuropathic pain induced by chronic constriction injury. Korean J Pain 2022; 35:391-402. [PMID: 36175338 PMCID: PMC9530680 DOI: 10.3344/kjp.2022.35.4.391] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 06/17/2022] [Accepted: 06/22/2022] [Indexed: 11/28/2022] Open
Abstract
Background The mechanism of peripheral axon transport in neuropathic pain is still unclear. Chemokine ligand 13 (CXCL13) and its receptor (C-X-C chemokine receptor type 5, CXCR5) as well as GABA transporter 1 (GAT-1) play an important role in the development of pain. The aim of this study was to explore the axonal transport of CXCL13/CXCR5 and GAT-1 with the aid of the analgesic effect of botulinum toxin type A (BTX-A) in rats. Methods Chronic constriction injury (CCI) rat models were established. BTX-A was administered to rats through subcutaneous injection in the hind paw. The pain behaviors in CCI rats were measured by paw withdrawal threshold and paw withdrawal latencies. The levels of CXCL13/CXCR5 and GAT-1 were measured by western blots. Results The subcutaneous injection of BTX-A relieved the mechanical allodynia and heat hyperalgesia induced by CCI surgery and reversed the overexpression of CXCL13/CXCR5 and GAT-1 in the spinal cord, dorsal root ganglia (DRG), sciatic nerve, and plantar skin in CCI rats. After 10 mmol/L colchicine blocked the axon transport of sciatic nerve, the inhibitory effect of BTX-A disappeared, and the levels of CXCL13/CXCR5 and GAT-1 in the spinal cord and DRG were reduced in CCI rats. Conclusions BTX-A regulated the levels of CXCL13/CXCR5 and GAT-1 in the spine and DRG through axonal transport. Chemokines (such as CXCL13) may be transported from the injury site to the spine or DRG through axonal transport. Axon molecular transport may be a target to enhance pain management in neuropathic pain.
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Affiliation(s)
- Huilian Bu
- Center of Pain Management, Department of Anesthesiology, Pain and Perioperative Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Pengfei Jiao
- Center of Pain Management, Department of Anesthesiology, Pain and Perioperative Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Zhengzhou University Academy of Medical Sciences, Zhengzhou, China
| | - Xiaochong Fan
- Center of Pain Management, Department of Anesthesiology, Pain and Perioperative Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yan Gao
- Neuroscience Research Institute, Zhengzhou University Academy of Medical Sciences, Zhengzhou, China
| | - Lirong Zhang
- School of Basic Medical Science, Zhengzhou University, Zhengzhou, China
| | - Haiming Guo
- Department of Anesthesiology, Pain and Perioperative Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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Yang Z, Wang C, Zhang X, Li J, Zhang Z, Tan Z, Wang J, Zhang J, Bai X. Stem cells from human exfoliated deciduous teeth attenuate trigeminal neuralgia in rats by inhibiting endoplasmic reticulum stress. Korean J Pain 2022; 35:383-390. [PMID: 36175337 PMCID: PMC9530689 DOI: 10.3344/kjp.2022.35.4.383] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 05/05/2022] [Accepted: 06/13/2022] [Indexed: 11/24/2022] Open
Abstract
Background The treatment of trigeminal neuralgia remains a challenging issue. Stem cells from human exfoliated deciduous teeth (SHED) provide optimized therapy for chronic pain. This study aimed to investigate the mechanisms underlying the attenuation of trigeminal neuralgia by SHED. Methods Trigeminal neuralgia was induced by chronic constriction injury of the infraorbital nerve. The mechanical threshold was assessed after model establishment and local SHED transplantation. Endoplasmic reticulum (ER) morphology and Caspase12 expression in trigeminal ganglion (TG) was evaluated as well. BiP expression was observed in PC12 cells induced by tunicamycin. Results The local transplantation of SHED could relieve trigeminal neuralgia in rats. Further, transmission electron microscopy revealed swelling of the ER in rats with trigeminal neuralgia. Moreover, SHED inhibited the tunicamycin-induced up-regulated expression of BiP mRNA and protein in vitro. Additionally, SHED decreased the up-regulated expression of Caspase12 mRNA and protein in the TG of rats caused by trigeminal neuralgia after chronic constriction injury of the infraorbital nerve mode. Conclusions This findings demonstrated that SHED could alleviate pain by relieving ER stress which provide potential basic evidence for clinical pain treatment.
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Affiliation(s)
- Zhijie Yang
- Department of Oral and Maxillofacial Surgery, Hospital of Stomatology, China Medical University, Shenyang, China.,Liaoning Provincial Key Laboratory of Oral Diseases, Shenyang, China
| | - Chun Wang
- Department of Anesthesia, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xia Zhang
- Liaoning Provincial Key Laboratory of Oral Diseases, Shenyang, China.,Painless Dental Treatment Center, Hospital of Stomatology, China Medical University, Shenyang, China
| | - Jing Li
- Department of Oral and Maxillofacial Surgery, Hospital of Stomatology, China Medical University, Shenyang, China.,Liaoning Provincial Key Laboratory of Oral Diseases, Shenyang, China
| | - Ziqi Zhang
- Department of Oral and Maxillofacial Surgery, Hospital of Stomatology, China Medical University, Shenyang, China.,Liaoning Provincial Key Laboratory of Oral Diseases, Shenyang, China
| | - Zhao Tan
- Department of Oral and Maxillofacial Surgery, Hospital of Stomatology, China Medical University, Shenyang, China.,Liaoning Provincial Key Laboratory of Oral Diseases, Shenyang, China
| | - Junyi Wang
- Department of Oral and Maxillofacial Surgery, Hospital of Stomatology, China Medical University, Shenyang, China.,Liaoning Provincial Key Laboratory of Oral Diseases, Shenyang, China
| | - Junyang Zhang
- Department of Oral and Maxillofacial Surgery, Hospital of Stomatology, China Medical University, Shenyang, China.,Liaoning Provincial Key Laboratory of Oral Diseases, Shenyang, China
| | - Xiaofeng Bai
- Department of Oral and Maxillofacial Surgery, Hospital of Stomatology, China Medical University, Shenyang, China.,Liaoning Provincial Key Laboratory of Oral Diseases, Shenyang, China
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45
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Topal İ, Özçelik N, Atayoğlu AT. Post-COVID-19 pain syndrome: a descriptive study in Turkish population. Korean J Pain 2022; 35:468-474. [PMID: 36175346 PMCID: PMC9530682 DOI: 10.3344/kjp.2022.35.4.468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 06/29/2022] [Accepted: 07/01/2022] [Indexed: 11/29/2022] Open
Abstract
Background The new type of corona virus has a wide range of symptoms. Some people who have COVID-19 can experience long-term effects from their infection, known as post-COVID conditions. The authors aimed to investigate prolonged musculoskeletal pain as a symptom of the post-COVID-19 condition. Methods This is a descriptive study on the patients who were diagnosed with COVID-19 in a university hospital, between March 2020 and March 2021. Patient records and an extensive questionnaire were used to obtain relevant demographic and clinical characteristics, including hospitalization history, comorbidities, smoking history, duration of the pain, the area of pain, and the presence of accompanying neuropathic symptoms. Results Of the diagnosed patients, 501 agreed to participate in the study. Among the participants, 318 had musculoskeletal pain during COVID-19 infection, and 69 of them reported prolonged pain symptoms as part of their a post-COVID condition which could not be attributed to any other cause. The mean duration of pain was 4.38 ± 1.73 months, and the mean pain level was 7.2 ± 4.3. Neuropathic pain symptoms such as burning sensation (n = 16, 23.2%), numbness (n = 15, 21.7%), tingling (n = 10, 14.5%), stinging (n = 4, 5.8%), freezing (n = 1, 1.4%) were accompanied in patients with prolonged musculoskeletal pain. Conclusions Patients with COVID-19 may develop prolonged musculoskeletal pain. In some patients, neuropathic pain accompanies it. Awareness of prolonged post-COVID-19 pain is crucial for its early detection and management.
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Affiliation(s)
- İlknur Topal
- Department of Physical Medicine and Rehabilitation, International School of Medicine, Istanbul Medipol University, Istanbul, Turkiye
| | - Necdet Özçelik
- Department of Ear Nose Throat Diseases, International School of Medicine, Istanbul Medipol University, Istanbul, Turkiye
| | - Ali Timuçin Atayoğlu
- Department of Family Medicine, International School of Medicine, Istanbul Medipol University, Istanbul, Turkiye
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46
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Bohyn C, Chaudhary SR, Cresswell M. Posttraumatic cicatricial sciatic nerve entrapment: dynamic imaging and percutaneous neurolysis. Skeletal Radiol 2022; 51:1889-1897. [PMID: 35169938 DOI: 10.1007/s00256-022-04015-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 02/04/2022] [Accepted: 02/07/2022] [Indexed: 02/02/2023]
Abstract
We describe a case of late-onset sciatic neuralgia due to cicatricial tethering of the sciatic nerve by a retracted torn hamstring muscle that was successfully treated with percutaneous neurolysis. Ultrasound and MRI showed a chronic complete avulsion of the proximal hamstring complex with fatty atrophy of the retracted hamstring muscles. Dynamic ultrasound and magnetic resonance imaging displayed tethering of the retracted hamstring complex to the sciatic nerve caused by cicatricial adhesions. Whereas hamstring injuries are highly prevalent sports injuries, there are only a small number of reported cases in the literature of late-onset sciatic nerve involvement. We highlight the benefits of dynamic ultrasound and magnetic resonance imaging and propose ultrasound-guided percutaneous neurolysis as a viable minimally invasive treatment option.
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Affiliation(s)
- Cedric Bohyn
- Department of Radiology, St Paul's Hospital, 1081 Burrard St, Vancouver, BC, Canada.
- Department of Radiology, AZ Monica, Antwerp, Belgium.
| | | | - Mark Cresswell
- Department of Radiology, St Paul's Hospital, 1081 Burrard St, Vancouver, BC, Canada
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Feng X, Fadaee N, Huynh D, Capati I, Towfigh S. Risks of therapeutic versus prophylactic neurectomies. Surg Endosc 2022; 36:6809-6814. [PMID: 34981229 DOI: 10.1007/s00464-021-08967-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 12/12/2021] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Neuralgia due to a peripheral nerve injury may result in chronic pain, requiring a therapeutic surgical neurectomy. Meanwhile, some neurectomies are performed prophylactically, such as during inguinal mesh removal. Outcomes and risks associated with neurectomies are largely unknown despite consensus panels recommending them. METHODS All patients who underwent neurectomy 2013-2020 were analyzed. Data collection included demographics, preoperative symptoms, and postoperative outcomes. Indications for neurectomy were categorized as "therapeutic" if the patient had preoperative neuralgia or "prophylactic" if neurectomy was deemed necessary intra-operatively. RESULTS 66 patients underwent 80 operations and a total of 122 neurectomies. On average, 1.5 neurectomies were performed per operation. Therapeutic neurectomies were performed in 42 (64%) patients and prophylactic in 34 (52%). The most commonly transected nerve was the ilioinguinal nerve. Average preoperative pain score was 5.8/10. On paired analysis, there was a significant reduction in pain after prophylactic neurectomy (2.5 points, p = 0.002) but not after therapeutic neurectomy. None of the nerves transected prophylactically had postoperative neuralgia, whereas 35% of the nerves transected therapeutically resulted in persistent or recurrent neuralgia (p < 0.001). To treat this, 21% required only nerve blocks and 9% required ablation or reoperative neurectomy. Three patients had complex regional pain syndrome (CRPS), a severe complication; all three were diagnosed with chronic pain syndrome pre-operatively. DISCUSSION We demonstrate that prophylactic neurectomy is largely safe. In contrast, a therapeutic neurectomy had a 35% risk of persistent or recurrent neuralgia, 9% required additional ablative or reoperative neurectomy. Three patients advanced from chronic pain syndrome to CRPS. We recommend the decision to perform a neurectomy be judicious and selective, especially in patients with known chronic pain syndrome. Prior to planning surgical neurectomy, other less invasive modalities should be exhausted and patients should be aware of its risks.
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Affiliation(s)
- Xiaoxi Feng
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Negin Fadaee
- Beverly Hills Hernia Center, 450 N Roxbury Dr. #224, Beverly Hills, CA, 90210, USA
| | - Desmond Huynh
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Isabel Capati
- Beverly Hills Hernia Center, 450 N Roxbury Dr. #224, Beverly Hills, CA, 90210, USA
| | - Shirin Towfigh
- Beverly Hills Hernia Center, 450 N Roxbury Dr. #224, Beverly Hills, CA, 90210, USA.
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Du X, Zhao W, Xu L, Zhang T, Li L, Huang B. Clinical Observation of CT-Guided Intervertebral Foramen Puncture and Radiofrequency Thermocoagulation for the Treatment of Refractory PHN in the Superior Thoracic Segment. Pain Physician 2022; 25:E767-E775. [PMID: 35901488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND Post-herpetic neuralgia (PHN) is a typical neuropathic pain. Conventional oral analgesics and nerve block therapy can only obtain temporary analgesia in many cases. This study summarized the clinical effect of CT-Guided intervertebral foramen puncture and radiofrequency thermocoagulation through the superior margin of costotransverse joint for the treatment of refractory PHN in the superior thoracic segment. OBJECTIVES To observe the efficacy of CT-Guided intervertebral foramen puncture and radiofrequency thermocoagulation (RFT) treatment of refractory PHN in the T1 ~ T3 spinal innervation area. STUDY DESIGN A retrospective, observational study. SETTING Pain department, Jiaxing and Hangzhou, China. METHODS Thirty-six patients with intractable superior thoracic PHN were admitted to the Pain Department. After the positioning image of CT was taken by prone, the upper thoracic segment was scanned in axial position with the layer thickness of 3 mm of spinal model.The puncture path was designed by selecting the slice of the foramen and costotransverse joint from the obtained images. The needle was inserted to the corresponding foramen. After confirmation by high and low frequency current stimulation tests, the RFT was performed at 90°C for 180s. A numeric rating scale (NRS) for pain was recorded before surgery, 2 hours, 1 week, 4 weeks and 8 weeks after surgery and the mental state was assessed with the SF-36 clinical questionnaire before surgery, 4 weeks and 8 weeks after surgery. RESULTS Following RFT intervention the measured pain NRS significantly decreased after 2 hours, 1 week, 4 weeks and 8 weeks (P < 0.01). SF-36 scores in all categories increased 4 and 8 weeks after the operation (P < 0.01). No serious adverse effects were reported during the study period and no hypoxemia was found under intraoperative nasal catheter oxygen inhalation. LIMITATIONS Limitations of this study include the small sample size, and nonrandomized retrospective design. CONCLUSION CT-Guided intervertebral foramen puncture and RFT through the superior margin of the costotransverse joint can effectively improve refractory PHN in the superior thoracic segment with good safety.
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Affiliation(s)
- Xindan Du
- Department of Pain Medicine, Zhejiang Hospital of Integrated Traditional Chinese and Western Medicine, Hangzhou, China
| | - Wensheng Zhao
- Department of Pain Medicine, Zhejiang Hospital of Integrated Traditional Chinese and Western Medicine, Hangzhou, China
| | - Lulu Xu
- Department of Pain Medicine, Zhejiang Hospital of Integrated Traditional Chinese and Western Medicine, Hangzhou, China
| | - Tieshan Zhang
- Department of Pain Medicine, Zhejiang Hospital of Integrated Traditional Chinese and Western Medicine, Hangzhou, China
| | - Langping Li
- Department of Anesthesiology, Ruijin Hospital/Luwan Branch, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Bing Huang
- Department of Pain Medicine, The Affiliated Hospital of Jiaxing University, Jiaxing City, Zhejiang Province, China
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Zhang X, Li ZX, Yin LJ, Chen H. Selective nerve block for the treatment of neuralgia in Kummell’s disease: A case report. World J Clin Cases 2022; 10:7523-7530. [PMID: 36158019 PMCID: PMC9353927 DOI: 10.12998/wjcc.v10.i21.7523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 04/01/2022] [Accepted: 06/03/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Neuralgia is frequently noted in patients with Kummell’s disease, and its mechanism is complex, rendering it challenging to treat. Percutaneous kyphoplasty (PKP) has been widely used to treat osteoporotic vertebral compression fractures with satisfactory outcomes. However, it is not optimal for managing severely collapsed vertebrae, as cement injection may not be feasible. This report describes the use of a selective nerve block for the treatment of neuralgia caused by severely collapsed vertebrae in a patient with Kummell’s disease.
CASE SUMMARY In our patient, three vertebrae were involved. The collapse of T11 was particularly severe. After managing T8 and T9 using PKP, these two segments were effectively strengthened; consequently, back pain was significantly relieved. However, the structure and strength of T11 could not be effectively restored using a minimally invasive surgical method because there was little room for cement injection. This caused obvious neuralgia according to the postoperative status of the PKP. Thus, we performed selective nerve blocks for the treatment of neuralgia, which resulted in satisfactory outcomes.
CONCLUSION Selective nerve block may be a possible therapeutic strategy for neuralgia due to severely collapsed vertebrae in Kummell’s disease.
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Affiliation(s)
- Xin Zhang
- Department of Anesthesiology and Perioperative Medicine, Shanghai The Fourth People’s Hospital Affiliated to Tongji University School of Medicine, Shanghai 200434, China
| | - Zong-Xi Li
- Department of Anesthesiology and Perioperative Medicine, Shanghai The Fourth People’s Hospital Affiliated to Tongji University School of Medicine, Shanghai 200434, China
| | - Li-Jun Yin
- Department of Anesthesiology and Perioperative Medicine, Shanghai The Fourth People’s Hospital Affiliated to Tongji University School of Medicine, Shanghai 200434, China
- Department of Anesthesiology, Ningbo Women and Children’s Hospital, Ningbo 315012, China
| | - Hui Chen
- Department of Anesthesiology and Perioperative Medicine, Shanghai The Fourth People’s Hospital Affiliated to Tongji University School of Medicine, shanghai 200434, China
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Owoyele BV, Bakare AO, Olaseinde OF, Ochu MJ, Yusuff AM, Ekebafe F, Fogabi OL, Roi T. Synergistic interaction between acetaminophen and L-carnosine improved neuropathic pain via NF-κB pathway and antioxidant properties in chronic constriction injury model. Korean J Pain 2022; 35:271-279. [PMID: 35768982 PMCID: PMC9251391 DOI: 10.3344/kjp.2022.35.3.271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 04/17/2022] [Accepted: 04/18/2022] [Indexed: 11/28/2022] Open
Abstract
Background Inflammation is known to underlie the pathogenesis in neuropathic pain. This study investigated the anti-inflammatory and neuroprotective mechanisms involved in antinociceptive effects of co-administration of acetaminophen and L-carnosine in chronic constriction injury (CCI)-induced peripheral neuropathy in male Wistar rats. Methods Fifty-six male Wistar rats were randomly divided into seven experimental groups (n = 8) treated with normal saline/acetaminophen/acetaminophen + L-carnosine. CCI was used to induce neuropathic pain in rats. Hyperalgesia and allodynia were assessed using hotplate and von Frey tests, respectively. Investigation of spinal proinflammatory cytokines and antioxidant system were carried out after twenty-one days of treatment. Results The results showed that the co-administration of acetaminophen and L-carnosine significantly (P < 0.001) increased the paw withdrawal threshold to thermal and mechanical stimuli in ligated rats compared to the ligated naïve group. There was a significant (P < 0.001) decrease in the levels of nuclear factor kappa light chain enhancer B cell inhibitor, calcium ion, interleukin-1-beta, and tumour necrotic factor-alpha in the spinal cord of the group coadministered with acetaminophen and L-carnosine compared to the ligated control group. Co-administration with acetaminophen and L-carnosine increased the antioxidant enzymatic activities and reduced the lipid peroxidation in the spinal cord. Conclusions Co-administration of acetaminophen and L-carnosine has anti-inflammatory effects as a mechanism that mediate its antinociceptive effects in CCI-induced peripheral neuropathy in Wistar rat.
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Affiliation(s)
- Bamidele Victor Owoyele
- Neuroscience and Inflammation Unit, Department of Physiology, Faculty of Basic Medical Sciences, University of Ilorin, Ilorin, Kwara State, Nigeria
| | - Ahmed Olalekan Bakare
- Neuroscience and Inflammation Unit, Department of Physiology, Adeleke University, Ede, Osun State, Nigeria
| | - Olutayo Folajimi Olaseinde
- Neuroscience and Inflammation Unit, Department of Physiology, Faculty of Basic Medical Sciences, University of Ilorin, Ilorin, Kwara State, Nigeria
| | - Mohammed Jelil Ochu
- Neuroscience and Inflammation Unit, Department of Physiology, Faculty of Basic Medical Sciences, University of Ilorin, Ilorin, Kwara State, Nigeria
| | - Akorede Munirdeen Yusuff
- Neuroscience and Inflammation Unit, Department of Physiology, Faculty of Basic Medical Sciences, University of Ilorin, Ilorin, Kwara State, Nigeria
| | - Favour Ekebafe
- Neuroscience and Inflammation Unit, Department of Physiology, Faculty of Basic Medical Sciences, University of Ilorin, Ilorin, Kwara State, Nigeria
| | - Oluwadamilare Lanre Fogabi
- Neuroscience and Inflammation Unit, Department of Physiology, Faculty of Basic Medical Sciences, University of Ilorin, Ilorin, Kwara State, Nigeria
| | - Treister Roi
- Department of Nursing, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
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