1
|
Yang J, Yang X, Zhao D, Wang X, Wei W, Yuan H. Association of time in range, as assessed by continuous glucose monitoring, with painful diabetic polyneuropathy. J Diabetes Investig 2021; 12:828-836. [PMID: 32885597 PMCID: PMC8089011 DOI: 10.1111/jdi.13394] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 08/03/2020] [Accepted: 08/24/2020] [Indexed: 12/15/2022] Open
Abstract
AIMS/INTRODUCTION This study aimed to evaluate the association between time in range (TIR) obtained from continuous glucose monitoring and the prevalence and degree of painful diabetic neuropathy. MATERIALS AND METHODS A total of 364 individuals with diabetic peripheral neuropathy were enrolled in this study. Sensor-based flash glucose monitoring systems were used to monitor the participants' glucose levels, and the glycemic variability metrics were calculated, including the TIR, glucose coefficient of variation, standard deviation and the mean amplitude of glycemic excursions. The participants were asked to record any form of pain during the 2 weeks of monitoring, and score the pain every day on a numerical rating scale. Based on the numerical rating scale, the patients were divided into the pain-free group, mild pain group and moderate/severe pain group. RESULTS Overall, 51.92% (189/364) of the participants were diagnosed with painful diabetic neuropathy. Compared with the pain-free group, the level of TIR decreased significantly in the mild pain and moderate/severe pain groups (P < 0.05). The prevalence of mild pain and moderate/severe pain decreased with increasing TIR quartiles (all P < 0.05). Multiple linear regression analysis showed that TIR was significantly negatively correlated with the numerical rating scale score after adjustment for glycated hemoglobin, glycemic variability indicators and other risk factors (P < 0.05). Logistic regression analysis showed that a decreasing level of TIR was significantly associated with an increasing risk of any pain and moderate/severe pain (P < 0.05). CONCLUSIONS TIR is correlated with painful diabetic neuropathy and is underscored as a valuable clinical evaluation measure.
Collapse
Affiliation(s)
- Junpeng Yang
- Department of EndocrinologyHenan Provincial People’s HospitalPeople’s Hospital of Zhengzhou UniversityZhengzhouChina
| | - Xueli Yang
- Department of EndocrinologyHenan Provincial People’s HospitalPeople’s Hospital of Zhengzhou UniversityZhengzhouChina
| | - Dongni Zhao
- Department of FinanceHenan Provincial People’s HospitalPeople’s Hospital of Zhengzhou UniversityZhengzhouChina
| | - Xiaobing Wang
- Department of EndocrinologyHenan Provincial People’s HospitalPeople’s Hospital of Zhengzhou UniversityZhengzhouChina
| | - Wei Wei
- Department of EndocrinologyHenan Provincial People’s HospitalPeople’s Hospital of Zhengzhou UniversityZhengzhouChina
| | - Huijuan Yuan
- Department of EndocrinologyHenan Provincial People’s HospitalPeople’s Hospital of Zhengzhou UniversityZhengzhouChina
| |
Collapse
|
2
|
Zhao J, Yang L, Huang L, Li Z. Screening of disease-related biomarkers related to neuropathic pain (NP) after spinal cord injury (SCI). Hum Genomics 2021; 15:5. [PMID: 33494823 PMCID: PMC7831171 DOI: 10.1186/s40246-021-00303-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 01/02/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Based on the molecular expression level, this paper compares lncRNA and mRNA expressions respectively in peripheral blood samples of the patients after SCI with NP and without NP, and screens disease-related biomarkers related to NP after SCI in peripheral blood samples of patients. METHOD The expression spectrum of 25 human peripheral blood samples (12 samples of refractory NP patients after SCI) was downloaded and data were normalized. Screening of GO annotations significantly associated with significant differentially expressed mRNAs and significant involvement of the KEGG pathway. The WGCNA algorithm was used to screen for modules and RNAs that were significantly associated with disease characterization. A co-expression network was constructed to extract the genes involved in the disease pathway from the co-expression network, construct a network of SCI pain-related pathways, and screen important disease-related biomarkers. Quantitative real-time PCR was used to detect the mRNA expression of hub genes. RESULTS Data were normalized and re-annotated by detection of platform information, resulting in a total of 289 lncRNA and 18197 mRNAs. Screening resulted in 338 significant differentially expressed RNAs that met the threshold requirements. Differentially expressed RNAs were significantly enriched with the brown and magenta modules. Six KEGG signaling pathways were screened in the co-expression network, and three KEGG pathways with direct neuropathic pain were identified. The expression levels of E2F1, MAX, MITF, CTNNA1, and ADORA2B in the disease group were all significantly upregulated (p < 0.01). Compared with the normal group, the expression of OXTR was upregulated. CONCLUSION We speculate that there are 7 genes and 2 lncRNAs directly involved in the pain pathway: E2F1, MAX, MITF, CTNNA1, ADORA2B, GRIK3, OXTR, LINC01119, and LINC02447. These molecules may be important for NP after SCI.
Collapse
Affiliation(s)
- Jia Zhao
- Department of Internal Neurology, The Third Hospital of Jilin University, 126 Xiantai Street, Changchun, 130000 Jilin, People’s Republic of China
| | - Li Yang
- Department of Internal Neurology, The Third Hospital of Jilin University, 126 Xiantai Street, Changchun, 130000 Jilin, People’s Republic of China
| | - Limin Huang
- Department of Internal Neurology , The Third Hospital of Jilin University , 126 Xiantai Street, Changchun, 130000 Jilin People’s Republic of China
| | - Zinan Li
- Department of Internal Neurology, The Third Hospital of Jilin University, 126 Xiantai Street, Changchun, 130000 Jilin, People’s Republic of China
| |
Collapse
|
3
|
Simo N, Kuate-Tegueu C, Ngankou-Tchankeu S, Doumbe J, Maiga Y, Cesari M, Dartigues JF, Kengne AP, Tabue-Teguo M. Correlates of diabetic polyneuropathy of the elderly in Sub-Saharan Africa. PLoS One 2020; 15:e0240602. [PMID: 33119646 PMCID: PMC7595408 DOI: 10.1371/journal.pone.0240602] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 09/29/2020] [Indexed: 02/02/2023] Open
Abstract
Background Diabetic polyneuropathy is associated with significant physical disability among older adults. However, their frequency and correlates are not well known in the older adults in Sub-Saharan-Africa. The objectives were to evaluate the hospital-based prevalence of diabetic polyneuropathy and identify its correlates in older adults. Methods Over a period of 5 months, a cross-sectional survey was carried out at Douala Laquintinie Hospital (DLH), a main reference hospital in Douala, the economic capital of Cameroon. Participants in our study group comprised all patients with type 2 diabetes, whatever the reason for their reporting to the hospital. Diabetic Polyneuropathy was defined according to a Diabetic Neuropathy Examination score > 3/16. Results A total of 159 older adults with diabetes were examined during this recruitment period, among whom 106 (66.7%) were women. The mean age was 68.3 ± 6.5 years. Diabetes median duration was 108 months. For all patients assessed using the Diabetic Neuropathy Examination score, polyneuropathy was reported in 31.4%; among them, polyneuropathy proved symptomatic in 78% of them. Correlates of polyneuropathy were glycated hemoglobin (p = 0.049), HIV infection (p = 0.031) and albuminuria (p< 0.001), even after adjustment for age, gender and duration of diabetes. Conclusion A third of older adults with diabetes who visited our hospital were diagnosed with prevalent diabetes-related polyneuropathy. It shows that early detection is required through routine screening and regular follow-up examinations in order to reduce the risk of disability and improve the quality of life in elderly diabetics.
Collapse
Affiliation(s)
- Nadine Simo
- CHU de Guadeloupe, Equipe LAMIA, Université des Antilles, Fouillole, Guadeloupe
| | - Callixte Kuate-Tegueu
- Faculty of Medicine and Biomedical Sciences, The University of Yaoundé 1, Yaounde, Cameroon
| | - Steve Ngankou-Tchankeu
- Institut Supérieur des Sciences de la Santé, Université des Montagnes, Bangangté, Cameroun
| | - Jacques Doumbe
- Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
| | - Youssoufa Maiga
- Service de Neurologie, Hôpital Gabriel Toure (CHU), Bamako, Mali
| | - Matteo Cesari
- Geriatric Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milano, Italy
| | | | - Andre-Pascal Kengne
- South African Medical Research Council of South Africa, Cape Town, South Africa
| | - Maturin Tabue-Teguo
- CHU de Guadeloupe, Equipe LAMIA, Université des Antilles, Fouillole, Guadeloupe
- INSERM U 1219, Université de Bordeaux, Bordeaux, France
- * E-mail:
| |
Collapse
|
4
|
Turan Yücel N, Can ÖD, Demir Özkay Ü. Catecholaminergic and opioidergic system mediated effects of reboxetine on diabetic neuropathic pain. Psychopharmacology (Berl) 2020; 237:1131-1145. [PMID: 31912189 DOI: 10.1007/s00213-019-05443-5] [Citation(s) in RCA: 4] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 12/27/2019] [Indexed: 10/25/2022]
Abstract
RATIONALE Current data indicate that the noradrenergic system plays a critical role in neuropathic pain treatment. Notably, drugs that directly affect this system may have curative potential in neuropathy-associated pain. OBJECTIVES The aim of this study was to evaluate the potential therapeutic efficacy of reboxetine, a potent and selective noradrenaline reuptake inhibitor, on hyperalgesia and allodynia responses in rats with experimental diabetes. Furthermore, mechanistic studies were performed to elucidate the possible mode of actions. METHODS Experimental diabetes was induced by a single dose of streptozotocin. Mechanical hyperalgesia, mechanical allodynia, thermal hyperalgesia, and thermal allodynia responses in diabetic rats were evaluated by Randall-Selitto, dynamic plantar, Hargreaves, and warm plate tests, respectively. RESULTS Reboxetine treatment (8 and 16 mg/kg for 2 weeks) demonstrated an effect comparable to that of the reference drug, pregabalin, improving the hyperalgesic and allodynic responses secondary to diabetes mellitus. Pretreatment with phentolamine, metoprolol, SR 59230A, and atropine did not alter the abovementioned effects of reboxetine; however, the administration of α-methyl-para-tyrosine methyl ester, propranolol, ICI-118,551, SCH-23390, sulpiride, and naltrindole significantly inhibited these effects. Moreover, reboxetine did not induce a significant difference in the rat plasma glucose levels. CONCLUSIONS Our findings indicate that the antihyperalgesic and antiallodynic effects of reboxetine are mediated by the catecholaminergic system; β2-adrenoceptors; D1-, D2/D3-dopaminergic receptors; and δ-opioid receptors. The results suggest that this analgesic effect of reboxetine, besides its neutral profile on glycemic control, may be advantageous in the pharmacotherapy of diabetic neuropathy-induced pain.
Collapse
Affiliation(s)
- Nazlı Turan Yücel
- Department of Pharmacology, Faculty of Pharmacy, Anadolu University, 26470, Eskisehir, Turkey.
| | - Özgür Devrim Can
- Department of Pharmacology, Faculty of Pharmacy, Anadolu University, 26470, Eskisehir, Turkey
| | - Ümide Demir Özkay
- Department of Pharmacology, Faculty of Pharmacy, Anadolu University, 26470, Eskisehir, Turkey
| |
Collapse
|
5
|
Angst DBM, Pinheiro RO, Vieira JSDS, Cobas RA, Hacker MDAVB, Pitta IJR, Giesel LM, Sarno EN, Jardim MR. Cytokine Levels in Neural Pain in Leprosy. Front Immunol 2020; 11:23. [PMID: 32038662 PMCID: PMC6992577 DOI: 10.3389/fimmu.2020.00023] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 01/07/2020] [Indexed: 12/20/2022] Open
Abstract
Pain is a frequent symptom in leprosy patients. It may be predominantly nociceptive, as in neuritis, or neuropathic, due to injury or nerve dysfunction. The differential diagnosis of these two forms of pain is a challenge in clinical practice, especially because it is quite common for a patient to suffer from both types of pain. A better understanding of cytokine profile may serve as a tool in assessing patients and also help to comprehend pathophysiology of leprosy pain. Patients with leprosy and neural pain (n = 22), neuropathic pain (n = 18), neuritis (nociceptive pain) (n = 4), or no pain (n = 17), further to those with diabetic neuropathy and neuropathic pain (n = 17) were recruited at Souza Araujo Out-Patient Unit (Fiocruz, Rio de Janeiro, RJ, Brazil). Serum levels of IL1β, IL-6, IL-10, IL-17, TNF, CCL-2/MCP-1, IFN-γ, CXCL-10/IP-10, and TGF-β were evaluated in the different Groups. Impairment in thermal or pain sensitivity was the most frequent clinical finding (95.5%) in leprosy neuropathy patients with and without pain, but less frequent in Diabetic Group (88.2%). Previous reactional episodes have occurred in patients in the leprosy and Pain Group (p = 0.027) more often. Analysis of cytokine levels have demonstrated that the concentrations of IL-1β, TNF, TGF-β, and IL-17 in serum samples of patients having leprosy neuropathy in combination with neuropathic or nociceptive pain were higher when compared to the samples of leprosy neuropathy patients without pain. In addition, these cytokine levels were significantly augmented in leprosy patients with neuropathic pain in relation to those with neuropathic pain due to diabetes. IL-1β levels are an independent variable associated with both types of pain in patients with leprosy neuropathy. IL-6 concentration was increased in both groups with pain. Moreover, CCL-2/MCP-1 and CXCL-10/IP-10 levels were higher in patients with diabetic neuropathy over those with leprosy neuropathy. In brief, IL-1β is an independent variable related to neuropathic and nociceptive pain in patients with leprosy, and could be an important biomarker for patient follow-up. IL-6 was higher in both groups with pain (leprosy and diabetic patients), and could be a therapeutic target in pain control.
Collapse
Affiliation(s)
- Débora Bartzen Moraes Angst
- Leprosy Laboratory, Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro, Brazil
- Postgraduate Program in Neurology of Federal University of Rio de Janeiro State (UNIRIO), Rio de Janeiro, Brazil
| | | | | | - Roberta Arnoldi Cobas
- Endocrinology Discipline of the Faculty of Medical Sciences, State University of Rio de Janeiro (UERJ), Rio de Janeiro, Brazil
| | | | - Izabela Jardim Rodrigues Pitta
- Leprosy Laboratory, Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro, Brazil
- Postgraduate Program in Neurology of Federal University of Rio de Janeiro State (UNIRIO), Rio de Janeiro, Brazil
| | - Louise Mara Giesel
- Leprosy Laboratory, Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro, Brazil
| | - Euzenir Nunes Sarno
- Leprosy Laboratory, Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro, Brazil
| | - Márcia Rodrigues Jardim
- Leprosy Laboratory, Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro, Brazil
- Postgraduate Program in Neurology of Federal University of Rio de Janeiro State (UNIRIO), Rio de Janeiro, Brazil
- Neurology Discipline of the Faculty of Medical Sciences, State University of Rio de Janeiro (UERJ), Rio de Janeiro, Brazil
| |
Collapse
|
6
|
Birmann PT, Sousa FSS, Domingues M, Brüning CA, Vieira BM, Lenardão EJ, Savegnago L. 3-(4-Chlorophenylselanyl)-1-methyl-1H-indole promotes recovery of neuropathic pain and depressive-like behavior induced by partial constriction of the sciatic nerve in mice. J Trace Elem Med Biol 2019; 54:126-133. [PMID: 31109602 DOI: 10.1016/j.jtemb.2019.04.014] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [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: 11/28/2018] [Revised: 04/18/2019] [Accepted: 04/23/2019] [Indexed: 01/16/2023]
Abstract
3-(4-Chlorophenylselanyl)-1-methyl-1H-indole (CMI) is an organoselenium compound that presents antioxidant activity, antinociceptive, anti-inflammatory and antidepressive-like effect in mice in previous studies conducted by our research group. In this study, we evaluate the anti-allodynic, anti-hyperalgesic and antidepressant-like effects of CMI on partial sciatic nerve ligation (PSNL) in male adult Swiss mice (25-35 g) as well as the involvement of oxidative stress in these effects. Mice underwent PSNL surgery and after 4 weeks they were treated with CMI (10 mg/kg, intragastric route [i.g.]) or vehicle. The treatment with CMI (10 mg/kg, i.g.) reversed the increased the percentage of response to Von-Frey Hair (VFH) stimulation, decreased the latency time to nociceptive response in the hot-plate test, increased immobility time in the forced swimming test (FST) and decreased groomings activity in the splash test, all induced by PSNL. Additionally, CMI also reversed increased the levels of reactive oxygen species (ROS) and lipid peroxidation in cortex and hippocampus and plasmatic levels of corticosterone in mice, induced by PSNL. Results demonstrate that CMI reversed behavioral and biochemical alterations in the dyad pain-depression induced by PSNL and possibly modulation of oxidative system.
Collapse
Affiliation(s)
- Paloma T Birmann
- Technologic Development Center, Biotechnology Unit, Neurobiotechnology Research Group, Federal University of Pelotas, Pelotas, RS, Brazil
| | - Fernanda S S Sousa
- Center of Chemical, Pharmaceutical and Food Sciences, Neurobiotechnology Research Group, Federal University of Pelotas, Pelotas, RS, Brazil
| | - Micaela Domingues
- Technologic Development Center, Biotechnology Unit, Neurobiotechnology Research Group, Federal University of Pelotas, Pelotas, RS, Brazil
| | - César A Brüning
- Center of Chemical, Pharmaceutical and Food Sciences, Neurobiotechnology Research Group, Federal University of Pelotas, Pelotas, RS, Brazil
| | - Beatriz M Vieira
- Center of Chemical, Pharmaceutical and Food Sciences, Laboratory of Clean Organic Synthesis, Federal University of Pelotas, Pelotas, RS, Brazil
| | - Eder J Lenardão
- Center of Chemical, Pharmaceutical and Food Sciences, Laboratory of Clean Organic Synthesis, Federal University of Pelotas, Pelotas, RS, Brazil
| | - Lucielli Savegnago
- Technologic Development Center, Biotechnology Unit, Neurobiotechnology Research Group, Federal University of Pelotas, Pelotas, RS, Brazil; Center of Chemical, Pharmaceutical and Food Sciences, Laboratory of Clean Organic Synthesis, Federal University of Pelotas, Pelotas, RS, Brazil.
| |
Collapse
|
7
|
Alkhatatbeh M, Abdul-Razzak KK. Neuropathic pain is not associated with serum vitamin D but is associated with female gender in patients with type 2 diabetes mellitus. BMJ Open Diabetes Res Care 2019; 7:e000690. [PMID: 31275577 PMCID: PMC6577304 DOI: 10.1136/bmjdrc-2019-000690] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2019] [Revised: 05/10/2019] [Accepted: 05/28/2019] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE Neuropathic pain is a common complication of diabetes mellitus (DM). Patients may complain of several neuropathic symptoms including impaired peripheral sensation, numbness, tingling, burning, and pain. Because these symptoms may cross with symptoms of vitamin D deficiency, we hypothesized that neuropathic pain and vitamin D deficiency may be associated in patients with type 2 DM. RESEARCH DESIGN AND METHODS This is a cross-sectional study that involved 239 participants with type 2 DM. Neuropathic pain was assessed using PainDETECT questionnaire. Serum 25-hydroxyvitamin D was measured by the electrochemiluminescence immunoassay, fasting blood glucose was measured by the hexokinase method and hemoglobin A1c was measured by the turbidimetric inhibition immunoassay. RESULTS The prevalence of neuropathic pain among type 2 DM participants was 26.8%. Vitamin D deficiency was reported in 67.8% of type 2 DM participants. The neuropathy score for females was significantly higher than that for males (p<0.01). There was no significant difference in serum vitamin D between type 2 DM participants according to their gender and according to their neuropathy status (p>0.05). Ordinal logistic regression analysis has shown that female gender was the only significant predictor of neuropathic pain among type 2 DM participants (p<0.01 with an OR (95% CI) of 2.45 (1.29 to 4.67)). CONCLUSIONS Neuropathic pain was not associated with serum vitamin D but was associated with female gender in type 2 DM. Because our results were not consistent with other studies that used different neuropathy assessment tools, we suggest that further research should be conducted to check the validity of these tools in identifying subjects with neuropathy.
Collapse
Affiliation(s)
- Mohammad Alkhatatbeh
- Clinical Pharmacy Department, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
| | - Khalid K Abdul-Razzak
- Clinical Pharmacy Department, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
| |
Collapse
|
8
|
Ziegler D, Strom A, Bönhof GJ, Kannenberg JM, Heier M, Rathmann W, Peters A, Meisinger C, Roden M, Thorand B, Herder C. Deficits in systemic biomarkers of neuroinflammation and growth factors promoting nerve regeneration in patients with type 2 diabetes and polyneuropathy. BMJ Open Diabetes Res Care 2019; 7:e000752. [PMID: 31803481 PMCID: PMC6887496 DOI: 10.1136/bmjdrc-2019-000752] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 11/04/2019] [Accepted: 11/06/2019] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION The determinants and mechanisms contributing to diabetic sensorimotor polyneuropathy (DSPN) remain unclear. Since neuroinflammation and altered nerve regeneration have been implicated in the pathogenesis of both DSPN and neuropathic pain, we hypothesized that the corresponding biomarkers could be associated with DSPN in general and could have the potential to discriminate between the painful and painless DSPN entities. METHODS In a cross-sectional study using multimarker proximity extension assay technology we assessed 71 serum biomarkers including cytokines, chemokines, growth factors, receptors, and others in patients with type 2 diabetes with DSPN (DSPN+) (n=304) or without DSPN (DSPN-) (n=158) and persons with normal glucose tolerance (NGT) without polyneuropathy (n=354). RESULTS After adjustment for multiple testing and sex, age, body mass index, HbA1c, and smoking, the serum levels of 17 biomarkers (four cytokines, five chemokines, four growth factors, two receptors, two miscellaneous) were lower in DSPN+ than in DSPN- and NGT. In DSPN+, six of these biomarkers were associated with peripheral nerve function. The concentrations of 15 other biomarkers differed between NGT and both DSPN+ and DSPN-, but not between DSPN+ and DSPN-. No differences in biomarker levels were found between patients with painful (n=164) and painless DSPN (n=140). CONCLUSIONS Deficits in systemic cytokines, chemokines, and growth factors promoting nerve regeneration in patients with type 2 diabetes are linked to polyneuropathy in general but not specifically to the painful or painless entity. TRIAL REGISTRATION NUMBER NCT02243475.
Collapse
Affiliation(s)
- Dan Ziegler
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany
- Division of Endocrinology and Diabetology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Alexander Strom
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany
| | - Gidon J Bönhof
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- Division of Endocrinology and Diabetology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Julia M Kannenberg
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany
| | - Margit Heier
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - Wolfgang Rathmann
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany
- Institute for Biometrics and Epidemiology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Annette Peters
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - Christina Meisinger
- Independent Research Group Clinical Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
- Chair of Epidemiology, Ludwig-Maximilians-Universität München am UNIKA-T Augsburg, Augsburg, Germany
| | - Michael Roden
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany
- Division of Endocrinology and Diabetology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Barbara Thorand
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - Christian Herder
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany
- Division of Endocrinology and Diabetology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| |
Collapse
|
9
|
Wang Y, Ye F, Huang C, Xue F, Li Y, Gao S, Qiu Z, Li S, Chen Q, Zhou H, Song Y, Huang W, Tan W, Wang Z. Bioinformatic Analysis of Potential Biomarkers for Spinal Cord-injured Patients with Intractable Neuropathic Pain. Clin J Pain 2018; 34:825-830. [PMID: 29547407 PMCID: PMC6078488 DOI: 10.1097/ajp.0000000000000608] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2017] [Revised: 10/05/2017] [Accepted: 10/22/2017] [Indexed: 12/30/2022]
Abstract
BACKGROUND Neuropathic pain is one of the common complications after spinal cord injury (SCI), affecting individuals' quality of life. The molecular mechanism for neuropathic pain after SCI is still unclear. We aimed to discover potential genes and microRNAs (miRNAs) related to neuropathic pain by the bioinformatics method. METHODS Microarray data of GSE69901 were obtained from Gene Expression Omnibus (GEO) database. Peripheral blood samples from individuals with or without neuropathic pain after SCI were collected. Twelve samples from individuals with neuropathic pain and 13 samples from individuals without pain as controls were included in the downloaded microarray. Differentially expressed genes (DEGs) between the neuropathic pain group and the control group were detected using the GEO2R online tool. Functional enrichment analysis of DEGs was performed using the DAVID database. Protein-protein interaction network was constructed from the STRING database. MiRNAs targeting these DEGs were obtained from the miRNet database. A merged miRNA-DEG network was constructed and analyzed with Cytoscape software. RESULTS In total, 1134 DEGs were identified between individuals with or without neuropathic pain (case and control), and 454 biological processes were enriched. We identified 4 targeted miRNAs, including mir-204-5p, mir-519d-3p, mir-20b-5p, mir-6838-5p, which may be potential biomarkers for SCI patients. CONCLUSION Protein modification and regulation of the biological process of the central nervous system may be a risk factor in SCI. Certain genes and miRNAs may be potential biomarkers for the prediction of and potential targets for the prevention and treatment of neuropathic pain after SCI.
Collapse
Affiliation(s)
- Yimin Wang
- Department of Anesthesiology, The First Affiliated Hospital of Sun Yat-sen University
- Department of Anesthesiology, Guangdong Second Provincial General Hospital, Guangzhou
| | - Fang Ye
- Department of Anesthesiology, The First Affiliated Hospital of Sun Yat-sen University
| | - Chanyan Huang
- Department of Anesthesiology, The First Affiliated Hospital of Sun Yat-sen University
| | - Faling Xue
- Department of Anesthesiology, The First Affiliated Hospital of Sun Yat-sen University
| | - Yingyuan Li
- Department of Anesthesiology, The First Affiliated Hospital of Sun Yat-sen University
| | - Shaowei Gao
- Department of Anesthesiology, The First Affiliated Hospital of Sun Yat-sen University
| | - Zeting Qiu
- Zhongshan School of Medicine, Sun Yat-sen University, Guangdong, China
| | - Si Li
- Zhongshan School of Medicine, Sun Yat-sen University, Guangdong, China
| | - Qinchang Chen
- Zhongshan School of Medicine, Sun Yat-sen University, Guangdong, China
| | - Huaqiang Zhou
- Zhongshan School of Medicine, Sun Yat-sen University, Guangdong, China
| | - Yiyan Song
- Zhongshan School of Medicine, Sun Yat-sen University, Guangdong, China
| | - Wenqi Huang
- Department of Anesthesiology, The First Affiliated Hospital of Sun Yat-sen University
| | - Wulin Tan
- Department of Anesthesiology, The First Affiliated Hospital of Sun Yat-sen University
| | - Zhongxing Wang
- Department of Anesthesiology, The First Affiliated Hospital of Sun Yat-sen University
| |
Collapse
|
10
|
Pai YW, Lin CH, Lee IT, Chang MH. Prevalence and biochemical risk factors of diabetic peripheral neuropathy with or without neuropathic pain in Taiwanese adults with type 2 diabetes mellitus. Diabetes Metab Syndr 2018; 12:111-116. [PMID: 29042249 DOI: 10.1016/j.dsx.2017.09.013] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [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: 09/06/2017] [Accepted: 09/26/2017] [Indexed: 12/20/2022]
Abstract
AIMS To investigate the prevalence and risk factors for diabetic peripheral neuropathy with or without neuropathic pain in Taiwanese. METHODS A cross-sectional, hospital-based observational study was conducted. We enrolled 2837 adults with type 2 diabetes mellitus. Diabetic peripheral neuropathy with or without pain were diagnosed using 2 validated screening tools, namely the Michigan Neuropathy Screening Instrument and Douleur Neuropathique 4 questionnaire. RESULTS In our sample, 2233 participants had no neuropathy, 476 had diabetic peripheral neuropathy without pain, and 128 had diabetic peripheral neuropathy with neuropathic pain, representing an overall diabetic peripheral neuropathy prevalence of 21.3%, and the prevalence of neuropathic pain in diabetic peripheral neuropathy was 21.2%. Multivariate analysis revealed that older age (P<0.001), treatment with insulin (P=0.004), microalbuminuria (P=0.001) or overt proteinuria (P<0.001) were independently associated with diabetic peripheral neuropathy, whereas older age (P<0.001), elevated glycated haemoglobin (P=0.011), lower high-density lipoprotein cholesterol (P=0.033), and overt proteinuria (P<0.001) were independently associated with diabetic peripheral neuropathy with neuropathic pain. CONCLUSIONS During clinical visits involving biochemical studies, the risk for diabetic peripheral neuropathy with neuropathic pain should be considered for people with older age, elevated glycated haemoglobin, low high-density lipoprotein cholesterol and overt proteinuria, with particular attention given to increased levels of albuminuria while concerning neuropathic pain.
Collapse
Affiliation(s)
- Yen-Wei Pai
- Neurological Institute, Taichung Veterans General Hospital, No. 1650, Taiwan Boulevard, Sec. 4, Taichung City 40705, Taiwan
| | - Ching-Heng Lin
- Department of Medical Research, Taichung Veterans General Hospital, No. 1650, Taiwan Boulevard, Sec. 4, Taichung City 40705, Taiwan
| | - I-Te Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, No. 1650, Taiwan Boulevard, Sec. 4, Taichung City 40705, Taiwan; Department of Medicine, School of Medicine, National Yang-Ming University, No. 155, Sec. 2, Linong Street, Taipei City 112, Taiwan; Department of Medicine, School of Medicine, Chung Shan Medical University, No.110, Sec.1, Jianguo N. Rd., Taichung City 40201, Taiwan
| | - Ming-Hong Chang
- Neurological Institute, Taichung Veterans General Hospital, No. 1650, Taiwan Boulevard, Sec. 4, Taichung City 40705, Taiwan; Department of Neurology, School of Medicine, National Yang-Ming University, No. 155, Sec. 2, Linong Street, Taipei City 112, Taiwan.
| |
Collapse
|
11
|
Weinsanto I, Mouheiche J, Laux-Biehlmann A, Aouad M, Maduna T, Petit-Demoulière N, Chavant V, Poisbeau P, Darbon P, Charlet A, Giersch A, Parat MO, Goumon Y. Lithium reverses mechanical allodynia through a mu opioid-dependent mechanism. Mol Pain 2018; 14:1744806917754142. [PMID: 29353538 PMCID: PMC5788089 DOI: 10.1177/1744806917754142] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background Lithium is widely used to treat bipolar disorders and displays mood stabilizing properties. In addition, lithium relieves painful cluster headaches and has a strong analgesic effect in neuropathic pain rat models. Objectives To investigate the analgesic effect of lithium on the cuff model of neuropathic pain. Methods We used behavioral and pharmacological approaches to study the analgesic effect of a single injection of lithium in wild-type and mu opioid receptor (MOR) null cuffed neuropathic mice. Mass spectrometry and enzyme-linked immunosorbent assay allowed to measure the levels of endogenous MOR agonist beta-endorphin as well as monoamines in brain and plasma samples 4 h after lithium administration. Results A single injection of lithium chloride (100 mg/kg, ip) alleviated mechanical allodynia for 24 h, and this effect was absent in MOR null neuropathic mice. Biochemical analyses highlight a significant increase in beta-endorphin levels by 30% in the brain of lithium-treated mice compared to controls. No variation of beta-endorphin was detected in the blood. Conclusions Together, our results provide evidence that lithium induces a long-lasting analgesia in neuropathic mice presumably through elevated brain levels of beta-endorphin and the activation of MORs.
Collapse
Affiliation(s)
- Ivan Weinsanto
- CNRS UPR3212, Institut des Neurosciences Cellulaires et Intégratives, Centre National de la Recherche Scientifique, Strasbourg, France
- University of Strasbourg, Strasbourg, France
| | - Jinane Mouheiche
- CNRS UPR3212, Institut des Neurosciences Cellulaires et Intégratives, Centre National de la Recherche Scientifique, Strasbourg, France
- University of Strasbourg, Strasbourg, France
| | - Alexis Laux-Biehlmann
- CNRS UPR3212, Institut des Neurosciences Cellulaires et Intégratives, Centre National de la Recherche Scientifique, Strasbourg, France
- University of Strasbourg, Strasbourg, France
| | - Maya Aouad
- CNRS UPR3212, Institut des Neurosciences Cellulaires et Intégratives, Centre National de la Recherche Scientifique, Strasbourg, France
- University of Strasbourg, Strasbourg, France
| | - Tando Maduna
- CNRS UPR3212, Institut des Neurosciences Cellulaires et Intégratives, Centre National de la Recherche Scientifique, Strasbourg, France
- University of Strasbourg, Strasbourg, France
| | - Nathalie Petit-Demoulière
- CNRS UPR3212, Institut des Neurosciences Cellulaires et Intégratives, Centre National de la Recherche Scientifique, Strasbourg, France
- University of Strasbourg, Strasbourg, France
| | - Virginie Chavant
- CNRS UPR3212, Institut des Neurosciences Cellulaires et Intégratives, Centre National de la Recherche Scientifique, Strasbourg, France
- University of Strasbourg, Strasbourg, France
- Mass Spectrometry Facilities, CNRS UPR3212, Institut des Neurosciences Cellulaires et Intégratives, Centre National de la Recherche Scientifique, Strasbourg, France
| | - Pierrick Poisbeau
- CNRS UPR3212, Institut des Neurosciences Cellulaires et Intégratives, Centre National de la Recherche Scientifique, Strasbourg, France
- University of Strasbourg, Strasbourg, France
| | - Pascal Darbon
- CNRS UPR3212, Institut des Neurosciences Cellulaires et Intégratives, Centre National de la Recherche Scientifique, Strasbourg, France
- University of Strasbourg, Strasbourg, France
| | - Alexandre Charlet
- CNRS UPR3212, Institut des Neurosciences Cellulaires et Intégratives, Centre National de la Recherche Scientifique, Strasbourg, France
- University of Strasbourg, Strasbourg, France
| | - Anne Giersch
- INSERM U-1114, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Département de Psychiatrie, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Marie-Odile Parat
- School of Pharmacy, University of Queensland, PACE, Woolloongabba, Australia
| | - Yannick Goumon
- CNRS UPR3212, Institut des Neurosciences Cellulaires et Intégratives, Centre National de la Recherche Scientifique, Strasbourg, France
- University of Strasbourg, Strasbourg, France
- Mass Spectrometry Facilities, CNRS UPR3212, Institut des Neurosciences Cellulaires et Intégratives, Centre National de la Recherche Scientifique, Strasbourg, France
- Yannick Goumon, INCI, CNRS UPR3212, 5, rue Blaise Pascal, F-67084 Strasbourg Cedex, France.
| |
Collapse
|
12
|
Velasco R, Navarro X, Gil-Gil M, Herrando-Grabulosa M, Calls A, Bruna J. Neuropathic Pain and Nerve Growth Factor in Chemotherapy-Induced Peripheral Neuropathy: Prospective Clinical-Pathological Study. J Pain Symptom Manage 2017; 54:815-825. [PMID: 28797868 DOI: 10.1016/j.jpainsymman.2017.04.021] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [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: 01/23/2017] [Revised: 03/11/2017] [Accepted: 04/12/2017] [Indexed: 12/27/2022]
Abstract
CONTEXT Neuropathic pain can be present in patients developing chemotherapy-induced peripheral neuropathy (CIPN). Nerve growth factor (NGF) is trophic to small sensory fibers and regulates nociception. OBJECTIVES We investigated the changes in serum NGF and intraepidermal nerve fiber density in skin biopsies of cancer patients receiving neurotoxic chemotherapy in a single-center prospective observational study. METHODS Patients were evaluated before and after chemotherapy administration. CIPN was graded with Total Neuropathy Score©, nerve conduction studies, and National Common Institute-Common Toxicity Criteria for Adverse Events scale. Neuropathic pain was defined according to the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-CIPN20 questionnaire. RESULTS Neuropathic pain was present in 13 of 60 patients (21%), who reported shooting or burning pain in the hands (n = 9) and the feet (n = 12). Patients displaying painful CIPN presented higher NGF after treatment compared with patients with painless or absent CIPN (8.7 ± 11.9 vs. 2.5 ± 1.4 pg/mL, P = 0.016). The change of NGF significantly correlated with neuropathic pain. Patients with painful CIPN did not show significant loss of IEFND compared with patients with painless or absent CIPN (6.16 ± 3.86 vs. 8.37 ± 4.82, P = 0.12). No correlation between IEFND and NGF was observed. CONCLUSION Serum NGF increases in cancer patients receiving taxane or platinum with painful CIPN, suggesting that it might be a potential biomarker of the presence and severity of neuropathic pain in this population. Long-term comprehensive studies to better define the course of NGF in relation with neurological outcomes would be helpful in the further design of therapies for CIPN-related neuropathic pain.
Collapse
Affiliation(s)
- Roser Velasco
- Neuro-Oncology Unit-IDIBELL, Hospital Universitari de Bellvitge-Institut Català d'Oncologia L'Hospitalet, Barcelona, Spain; Department of Cell Biology, Physiology and Immunology, Institute of Neurosciences, Universitat Autònoma de Barcelona, and Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Bellaterra, Spain
| | - Xavier Navarro
- Department of Cell Biology, Physiology and Immunology, Institute of Neurosciences, Universitat Autònoma de Barcelona, and Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Bellaterra, Spain
| | - Miguel Gil-Gil
- Neuro-Oncology Unit-IDIBELL, Hospital Universitari de Bellvitge-Institut Català d'Oncologia L'Hospitalet, Barcelona, Spain
| | - Mireia Herrando-Grabulosa
- Department of Cell Biology, Physiology and Immunology, Institute of Neurosciences, Universitat Autònoma de Barcelona, and Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Bellaterra, Spain
| | - Aina Calls
- Department of Cell Biology, Physiology and Immunology, Institute of Neurosciences, Universitat Autònoma de Barcelona, and Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Bellaterra, Spain
| | - Jordi Bruna
- Neuro-Oncology Unit-IDIBELL, Hospital Universitari de Bellvitge-Institut Català d'Oncologia L'Hospitalet, Barcelona, Spain; Department of Cell Biology, Physiology and Immunology, Institute of Neurosciences, Universitat Autònoma de Barcelona, and Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Bellaterra, Spain.
| |
Collapse
|
13
|
Werumeus Buning J, Konopka KH, Brummelman P, Koerts J, Dullaart RPF, van den Berg G, van der Klauw MM, Tucha O, Wolffenbuttel BHR, van Beek AP. Somatosensory function in patients with secondary adrenal insufficiency treated with two different doses of hydrocortisone-Results from a randomized controlled trial. PLoS One 2017; 12:e0180326. [PMID: 28686664 PMCID: PMC5501533 DOI: 10.1371/journal.pone.0180326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Accepted: 06/11/2017] [Indexed: 11/18/2022] Open
Abstract
Background Low cortisol levels are associated with several functional pain syndromes. In patients with secondary adrenal insufficiency (SAI), the lack in endogenous cortisol production is substituted by the administration of oral hydrocortisone (HC). Our previous study showed that a lower dose of HC led to an increase in reported subjective pain symptoms. Whether different doses of HC substitution alter somatosensory functioning in SAI patients has not been established yet. Methods In this randomized double blind cross-over trial, forty-six patients with SAI participated. Patients randomly received either first a lower dose (0.2–0.3 mg HC/kg body weight/day) for 10 weeks followed by a higher dose (0.4–0.6 mg HC/kg body weight/day) for another 10 weeks, or vice versa. After each treatment period, blood samples were drawn and somatosensory functioning was assessed by determining the mechanical detection threshold (MDT), mechanical pain threshold (MPT), mechanical pain sensitivity (MPS) and the pain pressure threshold (PPT), according to the Quantitative Sensory Testing (QST) battery by the German Network on Neuropathic Pain. Results The administration of the higher dose of HC resulted in significantly higher levels of cortisol (mean [SD] 748 [245] nmol/L) than the lower dose (537 [250] nmol/L, P<0.001). No differences were found in MDT, MPT, MPS and PPT z-scores between the two doses of HC. Furthermore, the number of patients showing sensory abnormalities did not differ between the two different doses. Conclusions The results suggest that the dose of HC has no impact on somatosensory functioning in response to mechanical stimuli in patients with SAI, despite previously found altered subjective pain reports.
Collapse
Affiliation(s)
- Jorien Werumeus Buning
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- * E-mail:
| | - Karl-Heinz Konopka
- Drug Discovery Science & Management-Europe, Astellas Pharma Europe B.V., Leiden, The Netherlands
| | - Pauline Brummelman
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Janneke Koerts
- Department of Clinical and Developmental Neuropsychology, University of Groningen, Groningen, The Netherlands
| | - Robin P. F. Dullaart
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Gerrit van den Berg
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Melanie M. van der Klauw
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Oliver Tucha
- Department of Clinical and Developmental Neuropsychology, University of Groningen, Groningen, The Netherlands
| | - Bruce H. R. Wolffenbuttel
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - André P. van Beek
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| |
Collapse
|
14
|
Luchting B, Heyn J, Woehrle T, Rachinger-Adam B, Kreth S, Hinske LC, Azad SC. Differential expression of P2X7 receptor and IL-1β in nociceptive and neuropathic pain. J Neuroinflammation 2016; 13:100. [PMID: 27145808 PMCID: PMC4857287 DOI: 10.1186/s12974-016-0565-z] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 04/27/2016] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Despite substantial progress, pathogenesis and therapy of chronic pain are still the focus of many investigations. The ATP-gated P2X7 receptor (P2X7R) has previously been shown to play a central role in animal models of nociceptive inflammatory and neuropathic pain. Recently, we found that the adaptive immune system is involved in the pathophysiology of chronic nociceptive and neuropathic pain in humans. So far, data regarding P2X7R expression patterns on cells of the adaptive immune system of pain patients are scarce. We therefore analyzed the P2X7R expression on peripheral blood lymphocytes and monocytes, as well as serum levels of IL-1β in patients suffering from chronic nociceptive and neuropathic pain in comparison to healthy volunteers in order to identify individuals who might benefit from a P2X7R modulating therapy. METHODS P2X7R messenger RNA (mRNA) and protein expression were determined in patients with either chronic nociceptive low back pain (CLBP) or neuropathic pain (NeP), and in healthy volunteers by quantitative real-time PCR (qPCR) and by fluorescence-assisted cell-sorting (FACS), respectively. IL-1β serum levels were measured with a multiplex cytokine assay. RESULTS Compared to healthy volunteers, P2X7R mRNA (1.6-fold, p = 0.038) and protein levels were significantly increased on monocytes (NeP: 24.6 ± 6.2, healthy volunteers: 17.0 ± 5.4; p = 0.002) and lymphocytes (NeP: 21.8 ± 6.5, healthy volunteers: 15.6 ± 5.2; p = 0.009) of patients with NeP, but not in patients with CLBP. Similarly, IL-1β serum concentrations were significantly elevated only in NeP patients (1.4-fold, p = 0.04). CONCLUSIONS A significant upregulation of P2X7R and increased IL-1β release seems to be a particular phenomenon in patients with NeP. P2X7R inhibitors may therefore represent a potential option for the treatment of this frequently intractable type of pain. German Clinical Trial Register (DRKS): Registration Trial DRKS00005954.
Collapse
Affiliation(s)
- Benjamin Luchting
- Department of Anesthesiology and Pain Medicine, LMU-Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Jens Heyn
- Department of Anesthesiology and Pain Medicine, LMU-Munich, Marchioninistrasse 15, 81377, Munich, Germany.
| | - Tobias Woehrle
- Department of Anesthesiology and Pain Medicine, LMU-Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Banafscheh Rachinger-Adam
- Department of Anesthesiology and Pain Medicine, LMU-Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Simone Kreth
- Department of Anesthesiology and Pain Medicine, LMU-Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Ludwig C Hinske
- Department of Anesthesiology and Pain Medicine, LMU-Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Shahnaz C Azad
- Department of Anesthesiology and Pain Medicine, LMU-Munich, Marchioninistrasse 15, 81377, Munich, Germany
| |
Collapse
|
15
|
Eliava M, Melchior M, Knobloch-Bollmann HS, Wahis J, da Silva Gouveia M, Tang Y, Ciobanu AC, Triana Del Rio R, Roth LC, Althammer F, Chavant V, Goumon Y, Gruber T, Petit-Demoulière N, Busnelli M, Chini B, Tan LL, Mitre M, Froemke RC, Chao MV, Giese G, Sprengel R, Kuner R, Poisbeau P, Seeburg PH, Stoop R, Charlet A, Grinevich V. A New Population of Parvocellular Oxytocin Neurons Controlling Magnocellular Neuron Activity and Inflammatory Pain Processing. Neuron 2016; 89:1291-1304. [PMID: 26948889 DOI: 10.1016/j.neuron.2016.01.041] [Citation(s) in RCA: 270] [Impact Index Per Article: 33.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Revised: 08/02/2015] [Accepted: 01/21/2016] [Indexed: 11/18/2022]
Abstract
Oxytocin (OT) is a neuropeptide elaborated by the hypothalamic paraventricular (PVN) and supraoptic (SON) nuclei. Magnocellular OT neurons of these nuclei innervate numerous forebrain regions and release OT into the blood from the posterior pituitary. The PVN also harbors parvocellular OT cells that project to the brainstem and spinal cord, but their function has not been directly assessed. Here, we identified a subset of approximately 30 parvocellular OT neurons, with collateral projections onto magnocellular OT neurons and neurons of deep layers of the spinal cord. Evoked OT release from these OT neurons suppresses nociception and promotes analgesia in an animal model of inflammatory pain. Our findings identify a new population of OT neurons that modulates nociception in a two tier process: (1) directly by release of OT from axons onto sensory spinal cord neurons and inhibiting their activity and (2) indirectly by stimulating OT release from SON neurons into the periphery.
Collapse
Affiliation(s)
- Marina Eliava
- Schaller Research Group on Neuropeptides at German Cancer Research Center (DKFZ) and Cell Network Cluster of Excellence at the University of Heidelberg, Heidelberg 69120, Germany
| | - Meggane Melchior
- Institut of Cellular and Integrative Neurosciences (INCI) UPR3212, Centre National de la Recherche Scientifique (CNRS), University of Strasbourg, Strasbourg 67084, France
| | - H Sophie Knobloch-Bollmann
- Schaller Research Group on Neuropeptides at German Cancer Research Center (DKFZ) and Cell Network Cluster of Excellence at the University of Heidelberg, Heidelberg 69120, Germany; Max Planck Institute for Medical Research, Heidelberg 69120, Germany
| | - Jérôme Wahis
- Institut of Cellular and Integrative Neurosciences (INCI) UPR3212, Centre National de la Recherche Scientifique (CNRS), University of Strasbourg, Strasbourg 67084, France
| | - Miriam da Silva Gouveia
- Schaller Research Group on Neuropeptides at German Cancer Research Center (DKFZ) and Cell Network Cluster of Excellence at the University of Heidelberg, Heidelberg 69120, Germany
| | - Yan Tang
- Schaller Research Group on Neuropeptides at German Cancer Research Center (DKFZ) and Cell Network Cluster of Excellence at the University of Heidelberg, Heidelberg 69120, Germany; Institute of Brain Functional Genomics, East China Normal University, Shanghai 200062, China
| | - Alexandru Cristian Ciobanu
- Center for Psychiatric Neurosciences, Hôpital de Cery, Lausanne University Hospital (CHUV), Lausanne 1008, Switzerland
| | - Rodrigo Triana Del Rio
- Center for Psychiatric Neurosciences, Hôpital de Cery, Lausanne University Hospital (CHUV), Lausanne 1008, Switzerland
| | - Lena C Roth
- Schaller Research Group on Neuropeptides at German Cancer Research Center (DKFZ) and Cell Network Cluster of Excellence at the University of Heidelberg, Heidelberg 69120, Germany; Max Planck Institute for Medical Research, Heidelberg 69120, Germany
| | - Ferdinand Althammer
- Schaller Research Group on Neuropeptides at German Cancer Research Center (DKFZ) and Cell Network Cluster of Excellence at the University of Heidelberg, Heidelberg 69120, Germany
| | - Virginie Chavant
- Institut of Cellular and Integrative Neurosciences (INCI) UPR3212, Centre National de la Recherche Scientifique (CNRS), University of Strasbourg, Strasbourg 67084, France
| | - Yannick Goumon
- Institut of Cellular and Integrative Neurosciences (INCI) UPR3212, Centre National de la Recherche Scientifique (CNRS), University of Strasbourg, Strasbourg 67084, France
| | - Tim Gruber
- Schaller Research Group on Neuropeptides at German Cancer Research Center (DKFZ) and Cell Network Cluster of Excellence at the University of Heidelberg, Heidelberg 69120, Germany; Max Planck Institute for Medical Research, Heidelberg 69120, Germany
| | - Nathalie Petit-Demoulière
- Institut of Cellular and Integrative Neurosciences (INCI) UPR3212, Centre National de la Recherche Scientifique (CNRS), University of Strasbourg, Strasbourg 67084, France
| | - Marta Busnelli
- National Research Council, Institute of Neuroscience, Milan 20129, Italy
| | - Bice Chini
- National Research Council, Institute of Neuroscience, Milan 20129, Italy; Humanitas Clinical and Research Center, Rozzano 20089, Italy
| | - Linette L Tan
- Department for Molecular Pharmacology and Molecular Medicine Partnership Unit with European Molecular Biology Laboratories, Institute of Pharmacology, Heidelberg University, Heidelberg 69120, Germany
| | - Mariela Mitre
- Skirball Institute of Biomolecular Medicine, New York University School of Medicine, New York, NY 10016, USA
| | - Robert C Froemke
- Skirball Institute of Biomolecular Medicine, New York University School of Medicine, New York, NY 10016, USA
| | - Moses V Chao
- Skirball Institute of Biomolecular Medicine, New York University School of Medicine, New York, NY 10016, USA
| | - Günter Giese
- Max Planck Institute for Medical Research, Heidelberg 69120, Germany
| | - Rolf Sprengel
- Max Planck Institute for Medical Research, Heidelberg 69120, Germany
| | - Rohini Kuner
- Department for Molecular Pharmacology and Molecular Medicine Partnership Unit with European Molecular Biology Laboratories, Institute of Pharmacology, Heidelberg University, Heidelberg 69120, Germany
| | - Pierrick Poisbeau
- Institut of Cellular and Integrative Neurosciences (INCI) UPR3212, Centre National de la Recherche Scientifique (CNRS), University of Strasbourg, Strasbourg 67084, France
| | - Peter H Seeburg
- Max Planck Institute for Medical Research, Heidelberg 69120, Germany
| | - Ron Stoop
- Center for Psychiatric Neurosciences, Hôpital de Cery, Lausanne University Hospital (CHUV), Lausanne 1008, Switzerland
| | - Alexandre Charlet
- Institut of Cellular and Integrative Neurosciences (INCI) UPR3212, Centre National de la Recherche Scientifique (CNRS), University of Strasbourg, Strasbourg 67084, France; University of Strasbourg Institute for Advanced Study (USIAS), Strasbourg 67000, France.
| | - Valery Grinevich
- Schaller Research Group on Neuropeptides at German Cancer Research Center (DKFZ) and Cell Network Cluster of Excellence at the University of Heidelberg, Heidelberg 69120, Germany; Max Planck Institute for Medical Research, Heidelberg 69120, Germany; Central Institute of Mental Health (ZI), Mannheim 68159, Germany.
| |
Collapse
|
16
|
Zhang YP, Mei S, Yang J, Rodriguez Y, Candiotti KA. Acute Hypoglycemia Induces Painful Neuropathy and the Treatment of Coenzyme Q10. J Diabetes Res 2016; 2016:4593052. [PMID: 26824041 PMCID: PMC4707338 DOI: 10.1155/2016/4593052] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Revised: 11/06/2015] [Accepted: 11/08/2015] [Indexed: 11/17/2022] Open
Abstract
Diabetic neuropathic pain is reduced with tight glycemic control. However, strict control increases the risk of hypoglycemic episodes, which are themselves linked to painful neuropathy. This study explored the effects of hypoglycemia-related painful neuropathy. Pretreatment with coenzyme Q10 (CoQ10) was performed to explore the preventive effect of CoQ10 on hypoglycemia-related acute neuropathic pain. Two strains of mice were used and 1 unit/kg of insulin was given to induce hypoglycemia. Mechanical sensitivity of hindpaw withdrawal thresholds was measured using von Frey filaments. Blood glucose levels were clamped at normal levels by joint insulin and glucose injection to test whether insulin itself induced hypersensitivity. Results suggest that the increased mechanical sensitivity after insulin injection is related to decreased blood glucose levels. When blood glucose levels remained at a normal level by the linked administration of insulin and glucose, mice demonstrated no significant change in mechanical sensitivity. Pretreatment with CoQ10 prevented neuropathic pain and the expression of the stress factor c-Fos. These results support the concept that pain in the diabetic scenario can be the result of hypoglycemia and not insulin itself. Additionally, pretreatment with CoQ10 may be a potent preventive method for the development of neuropathic pain.
Collapse
Affiliation(s)
- Yan Ping Zhang
- Department of Anesthesiology, Perioperative Medicine and Pain Management, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Shanshan Mei
- Department of Obstetrics and Gynecology, Guangzhou Women and Children's Medical Center, Guangzhou 510120, China
| | - Jinfeng Yang
- Department of Anesthesiology, The Affiliated Cancer Hospital of Xiangya School Of Medicine, Central South University, Changsha, Hunan 410013, China
| | - Yiliam Rodriguez
- Department of Anesthesiology, Perioperative Medicine and Pain Management, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Keith A. Candiotti
- Department of Anesthesiology, Perioperative Medicine and Pain Management, University of Miami Miller School of Medicine, Miami, FL 33136, USA
- *Keith A. Candiotti:
| |
Collapse
|
17
|
Xu Y, Zhang X, Pu S, Wu J, Lv Y, Du D. Circulating microRNA expression profile: a novel potential predictor for chronic nervous lesions. Acta Biochim Biophys Sin (Shanghai) 2014; 46:942-9. [PMID: 25274330 DOI: 10.1093/abbs/gmu090] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [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] [Indexed: 01/01/2023] Open
Abstract
The mechanisms of chronic neuropathic pain are not clear. Serum microRNAs (miRNAs) might show a special feature for chronic nervous lesions. However, little is known about the changes in circulating miRNAs for the neuropathic pain. Therefore, changes in the circulating miRNAs expression profile for the neuropathic pain were investigated. Serum was collected from rats before and after spinal nerve ligation (SNL) surgery, and a microarray analysis was performed to determine the changes in miRNA expression profile. The expression of inflammatory cytokines in serum from the same individuals, including interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), and monocyte chemotactic protein-1 (MCP-1), was also measured. The results showed that the expression levels of IL-6, TNF-α, and MCP-1 were significantly elevated in SNL rats which were significantly correlated with pain levels. Nine miRNAs with significantly different expression levels before and after SNL surgery were identified by microarray analysis, which were further validated by quantitative real-time polymerase chain reaction analyses. Compared with naive rats without SNL surgery, the expression of five miRNAs (hsa-miR-221, hsa-miR-34c, hsa-miR-21, hsa-miR-30a-5p, and hsa-miR-206) in the serum of rats after SNL surgery was decreased and four miRNAs (hsa-miR-31-5p, hsa-miR-133b, hsa-miR-22, and hsa-miRPlus-A1087) were increased, suggesting that miRNA changes may involve in the regulation of neuropathic pain. TargetScan was used to predict mRNA targets for these miRNAs, and the results showed that the transcripts with multiple predicted target sites belonged to neurologically important pathways. Bioinformatics analysis revealed that several target genes are related to the activation of cell signaling associated with nervous lesions. In this study, the changes to miRNA profiles in serum under neuropathic pain conditions were shown for the first time, suggesting that circulating miRNAs profile in serum is a potential predictor for neuropathic pain.
Collapse
Affiliation(s)
- Yongming Xu
- Pain Management Center and Department of Anesthesiology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiaotong University, Shanghai 200233, China
| | - Xin Zhang
- Pain Management Center and Department of Anesthesiology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiaotong University, Shanghai 200233, China
| | - Shaofeng Pu
- Pain Management Center and Department of Anesthesiology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiaotong University, Shanghai 200233, China
| | - Junzhen Wu
- Department of Anesthesiology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiaotong University, Shanghai 200233, China
| | - Yingying Lv
- Pain Management Center and Department of Anesthesiology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiaotong University, Shanghai 200233, China
| | - Dongping Du
- Pain Management Center and Department of Anesthesiology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiaotong University, Shanghai 200233, China
| |
Collapse
|
18
|
Pellkofer HL, Havla J, Hauer D, Schelling G, Azad SC, Kuempfel T, Magerl W, Huge V. The major brain endocannabinoid 2-AG controls neuropathic pain and mechanical hyperalgesia in patients with neuromyelitis optica. PLoS One 2013; 8:e71500. [PMID: 23951176 PMCID: PMC3739748 DOI: 10.1371/journal.pone.0071500] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Accepted: 07/01/2013] [Indexed: 11/18/2022] Open
Abstract
Recurrent myelitis is one of the predominant characteristics in patients with neuromyelitis optica (NMO). While paresis, visual loss, sensory deficits, and bladder dysfunction are well known symptoms in NMO patients, pain has been recognized only recently as another key symptom of the disease. Although spinal cord inflammation is a defining aspect of neuromyelitis, there is an almost complete lack of data on altered somatosensory function, including pain. Therefore, eleven consecutive patients with NMO were investigated regarding the presence and clinical characteristics of pain. All patients were examined clinically as well as by Quantitative Sensory Testing (QST) following the protocol of the German Research Network on Neuropathic Pain (DFNS). Additionally, plasma endocannabinoid levels and signs of chronic stress and depression were determined. Almost all patients (10/11) suffered from NMO-associated neuropathic pain for the last three months, and 8 out of 11 patients indicated relevant pain at the time of examination. Symptoms of neuropathic pain were reported in the vast majority of patients with NMO. Psychological testing revealed signs of marked depression. Compared to age and gender-matched healthy controls, QST revealed pronounced mechanical and thermal sensory loss, strongly correlated to ongoing pain suggesting the presence of deafferentation-induced neuropathic pain. Thermal hyperalgesia correlated to MRI-verified signs of spinal cord lesion. Heat hyperalgesia was highly correlated to the time since last relapse of NMO. Patients with NMO exhibited significant mechanical and thermal dysesthesia, namely dynamic mechanical allodynia and paradoxical heat sensation. Moreover, they presented frequently with either abnormal mechanical hypoalgesia or hyperalgesia, which depended significantly on plasma levels of the endogenous cannabinoid 2-arachidonoylglycerole (2-AG). These data emphasize the high prevalence of neuropathic pain and hyperalgesia in patients with NMO. The degree of mechanical hyperalgesia reflecting central sensitization of nociceptive pathways seems to be controlled by the major brain endocannabinoid 2-AG.
Collapse
Affiliation(s)
- Hannah L. Pellkofer
- Institute for Clinical Neuroimmunology, Ludwig-Maximilians University, Munich, Germany
- Department of Neurology, Ludwig-Maximilians University, Munich, Germany
- Department of Psychiatry and Psychotherapy, Georg August University, Göttingen, Germany
| | - Joachim Havla
- Institute for Clinical Neuroimmunology, Ludwig-Maximilians University, Munich, Germany
| | - Daniela Hauer
- Department of Anaesthesiology, Ludwig Maximilians University, Munich, Germany
| | - Gustav Schelling
- Department of Anaesthesiology, Ludwig Maximilians University, Munich, Germany
| | - Shahnaz C. Azad
- Department of Anaesthesiology, Ludwig Maximilians University, Munich, Germany
| | - Tania Kuempfel
- Institute for Clinical Neuroimmunology, Ludwig-Maximilians University, Munich, Germany
| | - Walter Magerl
- Chair of Neurophysiology, Center for Biomedicine and Medical Technology Mannheim (CBTM), Ruprecht Karls University Heidelberg, Mannheim, Germany
| | - Volker Huge
- Department of Anaesthesiology, Ludwig Maximilians University, Munich, Germany
- * E-mail:
| |
Collapse
|
19
|
Abstract
It is now increasingly being appreciated that a substantial proportion of subjects with prediabetes may exhibit peripheral neuropathy and/or neuropathic pain. The reverse is also true, inasmuch as examining patients with idiopathic peripheral neuropathy will frequently reveal prediabetes. In the general population, the prevalence of neuropathy in prediabetes is intermediate between overt diabetes and subjects with normoglycemia. This prediabetic neuropathy is, generally, milder in comparison to diabetic neuropathy and mainly affects small fibers mediating sensory function. Hyperglycemia, microangiopathy, dyslipidemia and the metabolic syndrome have been implicated as pathogenic mechanisms. In practice, therapy of prediabetic neuropathy should be addressed towards normoglycemia and correction of cardiovascular risk factors. However, additional work is needed to establish the long-term results of this approach.
Collapse
Affiliation(s)
- Nikolaos Papanas
- Institute for Clinical Diabetology, German Diabetes Center at the Heinrich Heine University, Leibniz Center for Diabetes Research, Düsseldorf, Germany.
| | | |
Collapse
|
20
|
Shumakher GI, Goriacheva MV, Sencheva NA, Travnikova TI, Kuznetsova MP. [Association of blood serum biochemical markers with neurologic syndromes in the exacerbation of dorsolumbar osteochondrosis]. Zh Nevrol Psikhiatr Im S S Korsakova 2012; 112:57-59. [PMID: 22677757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The content of C-reactive albumin (CRA) and endothelin-1 in patients with neurologic syndromes of dorsolumbar osteochondrosis (lumbodynia, lumboischialgia, lumbosacral radiculopathy) during exacerbation was investigated. CRA concentration in blood serum was determined by a highly sensitive quantitative method (in the interval from 0.1 g/l), based on the reaction of immunoprecipitation. Endothelin-1 content in the blood serum was determined by means of immunoenzymometric analysis method. The statistically significant (p<0,05) increase in concentrations of C-reactive albumin and endothelin-1 in the peripheral blood serum was found in 43 patients with lumbosacral radiculopathy compared to the control group and groups of patients with syndromes of lumbodynia and lumboischialgia. The direct correlation (r=0,71; p<0,01) between the content of CRA and endothelin-1 in the peripheral blood serum in patients with lumbosacral radiculopathy was established.
Collapse
|
21
|
Abstract
Between 25% and 62% of patients with idiopathic peripheral neuropathy are reported to have prediabetes, and among individuals with prediabetes 11-25% are thought to have peripheral neuropathy, and 13-21% have neuropathic pain. Population-based studies suggest a gradient for the prevalence of neuropathy, being highest in patients with manifest diabetes mellitus, followed by individuals with impaired glucose tolerance then impaired fasting glucose and least in those with normoglycemia. The most sensitive test to assess glucose metabolism status is the oral glucose tolerance test. Pathogenesis involves hyperglycemia, microvascular abnormalities, dyslipidemia and the metabolic syndrome. Individuals with prediabetes have less severe neuropathy than those with manifest diabetes mellitus. Sensory modalities are more frequently affected than motor modalities, but impairment of small nerve fibers could be the earliest detectable sign. Diagnosis should rely on careful clinical examination, with emphasis on the evaluation of small fibers. An oral glucose tolerance test should be performed in patients with idiopathic neuropathy. The only treatment with any efficacy is lifestyle modification to improve control of hyperglycemia and cardiovascular risk factors, but long-term efficacy of this approach has not been established. This Review summarizes the current evidence on the association between prediabetes and neuropathy.
Collapse
|
22
|
Abstract
Hypothyroidism is associated with a disturbance of behaviour and mood. There are also individuals, not classified as hypothyroid, with low to 'low normal' thyroid hormone levels and normal thyroid-stimulating hormone (TSH) levels who have mood and behavioural changes. As the peripheral thyroid hormones decrease, TSH is expected to increase. However, there are a number of physiological mechanisms known to suppress TSH. In the present study, we report on thyroid hormone regulation in a rat model of neuropathic pain and altered social behaviour that is usually transient, but is persistent in a sub-group of the population. Following ligation of the sciatic nerve, male Sprague-Dawley rats were assessed for social dominance towards an intruder: 20% showed persistently decreased social dominance. Plasma levels of thyroid hormones, TSH and corticosterone were measured before and on days 2, 3, 4, 5 and 6 after injury in 21 rats. The mean plasma thyroxine (T4), free thyroxine (fT4) and triiodothyronine (T3) levels decreased significantly post-injury in rats with persistently changed behaviour compared to rats with unchanged behaviour (P < or = 0.002). There was no significant difference between groups for mean change in free triiodothyronine (fT3) or TSH. There was a correlation between decreased dominance behaviour and decrease in both T4 (r = 0.62, P = 0.009) and fT4 (r = 0.71, P = 0.001), but no correlation with TSH. In a sub-population of rats, decreased thyroid hormones did not result in the expected increased levels of TSH to restore pre-injury levels, nor did they show increased hypothalamic thyrotrophin-releasing hormone mRNA expression, indicating altered hypothalamic-pituitary-thyroid axis regulation. Because T3 availability to the brain is dependent on both circulating T3 and T4, decreased peripheral thyroid hormones may result in changed neural function, as expressed in altered complex behaviours in this sub-population of rats.
Collapse
Affiliation(s)
- E Kilburn-Watt
- Medical Radiation Sciences, Faculty of Health Sciences, University of Sydney, and Australian Nuclear Science and Technology Organisation (ANSTO), Sydney, NSW, Australia
| | | | | |
Collapse
|
23
|
Ozkul A, Ayhan M, Yenisey C, Akyol A, Guney E, Ergin FA. The role of oxidative stress and endothelial injury in diabetic neuropathy and neuropathic pain. Neuro Endocrinol Lett 2010; 31:261-264. [PMID: 20424576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/18/2009] [Accepted: 02/22/2010] [Indexed: 05/29/2023]
Abstract
OBJECTIVE The roles of endothelin-1 (ET-1) and oxidative stress causing vascular injury in the pathogenesis of diabetic neuropathy are debatable. The present study was undertaken to clarify the possible effects of oxidative stress and ET-1 in diabetic patients with and without peripheric neuropathy. METHODS We studied plasma ET-1, nitric oxide (NO), catalase, glutathione (GSH) levels of fifty (22 females, 28 males) patients with Type 2 diabetes in order to evaluate endothelial dysfunction and oxidative stress. The neuropathy types (motor, sensorial and sensorimotor), comorbid diseases, antidiabetic treatments, smoking, diabetes duration were also considered. Short McGill Pain Questionnaire (SF-MPQ) was also performed for patients with neuropathy. RESULTS There were no significant differences between patients with (n=23) and without (n=27) neuropathy with regards to demographic features except diabetic disease duration. The statistical analysis was done considering this difference. Although NO and ET-1 levels were higher, and catalase and GSH levels were decreased in neuropathic patients, no statistical significancy was found. We also couldn't find any correlations between the parameters and SF-MPQ scores. CONCLUSIONS Although there were no relationships between neuropathy and the studied parameters, we found lower levels of catalase and GSH as intracelluler antioxidants and higher NO and ET-1 as markers of endothelial injury in patients with neuropathy. Our data suggest that there is a need of further studies with larger study groups in order to clear out the role of endothelial injury and oxidative status in the pathogenesis of diabetic neuropathy.
Collapse
Affiliation(s)
- Ayca Ozkul
- Department of Neurology, Adnan Menderes University, Medical Faculty, Turkey.
| | | | | | | | | | | |
Collapse
|
24
|
Abstract
BACKGROUND Pain is a common symptom in peripheral neuropathies. The factors determining why some peripheral neuropathies are painful and others are not are incompletely understood. Pro-inflammatory cytokines have been implicated to play a crucial role in the generation of pain. OBJECTIVE To investigate whether cytokine profiles differ between patients with painful or painless neuropathy. METHODS In this prospective study, we analyzed blood mRNA and protein levels of the pro-inflammatory cytokines interleukin-2 (IL-2) and tumor necrosis factor-alpha (TNF) and the anti-inflammatory cytokines IL-4 and IL-10 in 32 patients with painful neuropathy, 20 patients with painless neuropathy, and 38 healthy control subjects, using quantitative real-time PCR and ELISA. RESULTS Patients with a painful neuropathy had about twofold higher IL-2 mRNA (p = 0.001) and TNF mRNA (p < 0.0001) and protein levels (p = 0.009) than healthy control subjects and about twofold higher IL-2 and TNF mRNA (p = 0.03; p = 0.001) and protein levels (p = 0.04; p = 0.04) than patients with painless neuropathy. In contrast, mRNA levels of the anti-inflammatory cytokine IL-10 were about twofold higher in patients with painless neuropathy than in patients with painful neuropathy (p = 0.001) and controls (p = 0.004). IL-4 protein levels were 20-fold higher in patients with painless neuropathy (p < 0.0001) and 17-fold higher in patients with painful neuropathy (p < 0.0001) than in healthy control subjects. CONCLUSIONS A pro-inflammatory cytokine profile seems to be associated with pain in the setting of a peripheral neuropathy, corroborating findings in animal models with experimental painful neuropathies. This may have implications for future treatment strategies.
Collapse
Affiliation(s)
- Nurcan Uçeyler
- Department of Neurology, University of Würzburg, Würzburg, Germany.
| | | | | | | |
Collapse
|
25
|
Wernicke JF, Pritchett YL, D'Souza DN, Waninger A, Tran P, Iyengar S, Raskin J. A randomized controlled trial of duloxetine in diabetic peripheral neuropathic pain. Neurology 2006; 67:1411-20. [PMID: 17060567 DOI: 10.1212/01.wnl.0000240225.04000.1a] [Citation(s) in RCA: 329] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Serotonin (5-HT) and norepinephrine (NE) are involved in pain modulation via descending inhibitory pathways in the brain and spinal cord. OBJECTIVE To assess the efficacy of duloxetine, a dual reuptake inhibitor of 5-HT and NE, on the reduction of pain severity, as well as secondary outcome measures in patients with diabetic peripheral neuropathic pain (DPNP). METHODS In this double-blind study, patients with DPNP and without comorbid depression were randomly assigned to treatment with duloxetine 60 mg once daily (QD), duloxetine 60 mg twice daily (BID), or placebo for 12 weeks. The primary outcome measure was the weekly mean score of 24-hour average pain severity on the 11-point Likert scale. Secondary measures and health outcome measures were also assessed. RESULTS Duloxetine 60 mg QD and 60 mg BID demonstrated improvement in the management of DPNP and showed rapid onset of action, with separation from placebo beginning at week 1 on the 24-hour average pain severity score. For all secondary measures for pain (except allodynia), mean changes showed an advantage of duloxetine over placebo, with no significant difference between 60 mg QD and 60 mg BID. Clinical Global Impression of Severity and Patient's Global Impression of Improvement evaluation demonstrated greater improvement on duloxetine- vs placebo-treated patients. Duloxetine showed no notable interference on diabetic controls, and both doses were safely administered. CONCLUSIONS This study confirms previous findings that duloxetine at 60 mg QD and 60 mg BID is effective and safe in the management of diabetic peripheral neuropathic pain.
Collapse
Affiliation(s)
- J F Wernicke
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN 46285, USA.
| | | | | | | | | | | | | |
Collapse
|
26
|
Zanjani TM, Sabetkasaei M, Mosaffa N, Manaheji H, Labibi F, Farokhi B. Suppression of interleukin-6 by minocycline in a rat model of neuropathic pain. Eur J Pharmacol 2006; 538:66-72. [PMID: 16687137 DOI: 10.1016/j.ejphar.2006.03.063] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2005] [Revised: 02/24/2006] [Accepted: 03/28/2006] [Indexed: 12/21/2022]
Abstract
Inflammatory mediators produced in the injured nerve have been proposed as contributing factors in the development of neuropathic pain. In this regard an important role is assigned to interleukin-6. The present study, evaluated the effect of pretreatment with minocycline, on pain behavior (hyperalgesia and allodynia) and serum level of interleukin-6 in chronic constriction injury (CCI) model of neuropathic pain in rat. Minocycline (5, 10, 20 and 40 mg/kg, i.p.) was injected 1 h before surgery and continued daily to day 14 post-ligation. Behavioral tests were recorded before surgery and on postoperative days 1, 3, 5, 7, 9, 10, 14, and the serum concentration of interleukin-6 was determined at day 14. We observed that minocycline which was reported to have a neuroprotective effect in some neurodegenerative diseases, reversed hyperalgesia and allodynia due to sciatic nerve ligation and inhibited the interleukin-6 production. It seems that minocycline could have an anti-inflammatory and analgesic effect in some chronic pain states.
Collapse
Affiliation(s)
- Taraneh Moini Zanjani
- Shahid Baheshti University of Medical Sciences, Department of Pharmacology and Neuroscience Research Center, Tehran, Iran
| | | | | | | | | | | |
Collapse
|
27
|
Abstract
BACKGROUND Central sensitization of neuropathic pain is associated with an influx of extracellular calcium via the opening of N-methyl-D-aspartate (NMDA) receptor-gated ion channels, which are usually blocked by magnesium plugs. As magnesium-deficient rats develop a mechanical hyperalgesia and intrathecal or intraperitoneal magnesium suppresses neuropathic pain, the magnesium concentrations in serum and cerebrospinal fluid may be altered in neuropathic pain. We therefore compared the magnesium concentrations in serum and cerebrospinal fluid of neuropathic rats with those in injured rats without symptoms of neuropathic pain and normal rats. METHODS Mechanical allodynia was induced in male Sprague-Dawley rats by tight ligature of the left lumbar fifth and sixth spinal nerves. The threshold of paw withdrawal was evaluated by the up-down method using withdrawal response to stimulus with a von Frey filament on the third, seventh and 14th days. Rats with a threshold of less than 4 g were selected as the symptomatic group and compared with an asymptomatic group, an unoperated control group and a sham-operated group. On the 16th day, the Mg2+ concentrations in serum and cerebrospinal fluid were measured. RESULTS The magnesium concentrations in the serum and cerebrospinal fluid of symptomatic neuropathic rats did not differ from those in the injured rats without symptoms of neuropathic pain, sham-operated rats and normal rats. CONCLUSION Our results suggest that physiologic homeostasis is maintained by active transport through the blood-brain barrier despite the activation of NMDA receptor-gated ion channels. However, rats with neuropathic pain may be in a magnesium-deficient condition at the effector site, such that magnesium treatment can decrease neuropathic pain.
Collapse
Affiliation(s)
- S M Jeong
- Department of Anesthesiology and Pain Medicine, College of Medicine, University of Ulsan, Asan Medical Center, Songpa-gu, Seoul, South Korea
| | | | | | | | | | | |
Collapse
|
28
|
Abstract
Plasma concentrations of soluble tumor necrosis factor alpha (TNF-alpha) receptor type I (sTNF-RI) were assessed in two complex regional pain syndrome (CRPS) patient groups (n = 30 and n = 16) and healthy controls (n = 25). Patients with CRPS and mechanical hyperalgesia had higher levels of sTNF-RI (1,661.8 +/- 146.8 pg/mL) compared with those with CRPS with identical clinical appearance but without hyperalgesia (1,155.9 +/- 56.3 pg/mL) and controls (1,239.5 +/- 42.9 pg/mL). This study suggests involvement of TNF-alpha in mechanical hyperalgesia of CRPS.
Collapse
Affiliation(s)
- Christian Maihöfner
- Department of Neurology, University of Erlangen-Nuremberg, Erlangen, Germany.
| | | | | | | |
Collapse
|
29
|
Abstract
Headache syndromes can be associated with focal neurological symptoms or signs. Good knowledge of primary headaches, a detailed history and a thorough clinical examination are prerequisites for their differential diagnosis. The neurological symptoms produced by the migraine aura are the most characteristic and recognisable. However, structural lesions, such as vascular malformations, can produce similar symptoms to migraine with aura, which highlights that paraclinical investigations are necessary in most patients with headache and focal neurological symptoms. In this review, we provide an overview of the differential diagnosis of the most common headache disorders with focal neurological symptoms or signs to refresh the practising neurologist's differential diagnostic knowledge for the clinical situation and to aid the teaching of neurology residents.
Collapse
Affiliation(s)
- Jean Schoenen
- Department of Neurology, Headache Research Unit, University of Liège, Belgium.
| | | |
Collapse
|
30
|
Negri E, Bettaglio R, Demartini L, Allegri M, Barbieri M, Miotti D, Paulin L, Buonocore M, Bonezzi C. [Validation of the Italian version of the "Neuropathic Pain Scale" and its clinical applications]. Minerva Anestesiol 2002; 68:95-104. [PMID: 11981518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
BACKGROUND The Neuropathic Pain Scale is the first specific tool to measure and analyse pain due to a lesion in the nervous system; this kind of pain is usually difficult to describe for the patient because it is characterized by unusual qualities. Aim of this study is to evaluate a possible relation between pain descriptions and underlying pathogenetic mechanisms. METHODS The Italian version of the Neuropathic Pain Scale has been administered to 145 patients with neuropathic pain due to chronic radiculopathy, diabetic neuropathy, post-traumatic neuropathy, Complex Regional Pain Syndrome or postherpetic neuralgia. As it has been done in Galer's study, the predictive validity and the items' correlation have been evaluated; moreover, the structure validity of the scale has been studied. RESULTS Pain values were high in all pain syndromes with the prevalence of certain items in particular pathologies. The correlation of some items with "deep pain" and others with "superficial pain" was also observed. CONCLUSIONS The results have confirmed the statistical validity of the Italian version of the scale; they also pointed out the usefulness of the scale to distinguish between superficial pain, typical of neuropathic pain, and deep pain, typical of somatic pain.
Collapse
Affiliation(s)
- E Negri
- Unità Operativa di Cure Palliative e Terapia del Dolore, Fondazione Salvatore Maugeri, IRCCS, Istituto Scientifico, Pavia, Italy
| | | | | | | | | | | | | | | | | |
Collapse
|
31
|
Abstract
OBJECTIVE To characterize a cohort of patients with neuropathy and impaired glucose tolerance (IGT) but no other identifiable cause of neuropathy. Of patients with diabetes, 10% have peripheral neuropathy at the time of their diagnosis, suggesting that axonal injury may occur early in the course of glucose intolerance. The American Diabetes Association (ADA) revised diagnostic criteria to recognize IGT (a serum glucose between 140 and 200 mg/dl in a 2-h oral glucose tolerance test [OGTT]) as a risk factor for cardiovascular disease independent of development of diabetes. RESEARCH DESIGN AND METHODS Using revised ADA criteria for diabetes and IGT, we prospectively evaluated 107 sequential patients with idiopathic neuropathy. RESULTS A total of 13 of the 107 patients had diabetes, whereas 36 (34%) had IGT, nearly three times the prevalence in age-matched control subjects (P < 0.01). OGTT was often elevated, whereas both fasting plasma glucose and HbA(1c) were normal. Comparing patients with diabetes, IGT, or normal OGTT, age and BMI were similar. However, painful sensory symptoms were more common in patients with IGT and diabetes, and family history of neuropathy was significantly more common in normoglycemic patients. Electrodiagnostic findings of axonal injury were less severe in patients with IGT and were more likely to be confined to sensory fibers than in patients with diabetes. CONCLUSIONS Our results suggest that IGT may cause or contribute to small-fiber neuropathy, which is similar in phenotype to the painful sensory neuropathy commonly encountered in diabetes. Two-hour OGTT is more sensitive than other measures of glucose handling in screening these patients.
Collapse
Affiliation(s)
- J R Singleton
- Division of Neuromuscular Disease, Department of Neurology, University of Utah, Salt Lake City, Utah 84132, USA.
| | | | | |
Collapse
|
32
|
Abstract
Gabapentin, which has been approved for add-on therapy of focal seizures, is increasingly used for treatment of neuropathic pain. Its analgesic effect is supposed to be due to reduction of glutamatergic transmission, improvement of GABAergic transmission and to binding to voltage-dependent calcium channels. Experimental studies demonstrated an ameliorating effect of gabapentin on neuropathic pain. Placebo-controlled studies revealed an efficacy of gabapentin against pain in diabetic neuropathy and postherpetic neuralgia and in prophylaxis of migraine. Case reports show an analgesic effect of gabapentin in trigeminus neuralgia and in reflex sympathetic dystrophy. The main adverse events are dizziness, ataxia and somnolence. Controlled studies, which compare the efficacy of gabapentin with that of the respective reference drug, are needed to evaluate its importance in treatment of pain.
Collapse
Affiliation(s)
- F Block
- Neurologische Klinik, RWTH Aachen.
| |
Collapse
|
33
|
|
34
|
Abstract
Recent studies have reported the possibilities of relieving neuropathic pain by administering adenosine or its analogs. In order to determine if there exists a metabolic anomaly of this nucleoside in patients with neuropathic pain, circulating adenosine levels were compared in three patient groups. The first was composed of individuals suffering from neuropathic pain, the second of patients with nervous system lesions in the absence of pain, and the third was composed of patients suffering from pain resulting from excessive nociception. The adenosine blood levels of these patients were compared to those of a control group. Finally, adenosine in the cerebrospinal fluid (CSF) of some patients was also assayed. The results show that there are reduced levels of blood and CSF adenosine in patients with neuropathic pain. This adenosine deficiency could explain the potential therapeutic effects of administering adenosine or its analogs.
Collapse
Affiliation(s)
- R Guieu
- Laboratoire de Biochimie, URA CNRS 1455, Faculté de Médecine Secteur Nord, Marseille, France
| | | | | | | | | | | | | | | |
Collapse
|
35
|
Milovanovic DD, Stevanovic HL, Pavlovic J. Plasma tryptophan levels in the patients with cervicobrachial and lumbosacral pain syndromes. Adv Exp Med Biol 1996; 398:107-11. [PMID: 8906251 DOI: 10.1007/978-1-4613-0381-7_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
|
36
|
Eide PK, Stubhaug A, Øye I, Breivik H. Continuous subcutaneous administration of the N-methyl-D-aspartic acid (NMDA) receptor antagonist ketamine in the treatment of post-herpetic neuralgia. Pain 1995; 61:221-228. [PMID: 7659432 DOI: 10.1016/0304-3959(94)00182-e] [Citation(s) in RCA: 185] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The effect of continuous subcutaneous (s.c.) infusion of ketamine on nerve injury pain was examined in patients with post-herpetic neuralgia. Five patients that reported pain relief after acute intravenous injection of ketamine were included in this open prospective study. Ketamine was administered continuously in increasing doses using a portable infusion pump (CADD-PLUS, Pharmacia), and the treatment period for each infusion rate (0.05, 0.075, 0.10, or 0.15 mg/kg/h) was 7 days and nights. Relief of continuous pain, as evaluated daily by visual analogue scales, was observed at the infusion rate of 0.05 mg/kg/h, but was most marked during infusion of 0.15 mg/kg/h. All the patients reported that ketamine reduced the severity of continuous pain as well as reduced the severity and number of attacks of spontaneous pain. Changes in evoked pain (allodynia and wind-up-like pain) were recorded before change of infusion rate. Allodynia was maximally reduced 59-100% after 1 week infusion of 0.05 mg/kg/h, and wind-up-like pain was maximally reduced 60-100% after 1 week infusion of 0.15 mg/kg/h. Itching and painful indurations at the injection site was the most bothersome side-effect and for this reason 1 patient discontinued treatment after 2 weeks. Other common side-effects were nausea, fatigue and dizziness. The present results show that continuous, spontaneous and evoked pain in patients with post-herpetic neuralgia is reduced by continuous s.c. infusion of ketamine, but is associated with intolerable side effects.
Collapse
Affiliation(s)
- Per Kristian Eide
- Department of Neurosurgery, Ullevål Hospital, Oslo Norway Department of Anesthesiology, The National Hospital, Oslo Norway Department of Pharmacology, University of Oslo, Oslo Norway
| | | | | | | |
Collapse
|
37
|
Abstract
Postherpetic neuralgia (PHN) following herpes zoster is a common and disabling neuropathic pain syndrome. In a double-blind, three-session study, 5% lidocaine gel or vehicle was applied simultaneously to both the area of pain and to the contralateral mirror-image unaffected skin. In the local session, lidocaine gel was applied to the painful skin area. In the remote session, lidocaine gel was applied to mirror-image skin. In the placebo session, vehicle was applied bilaterally. For cranial PHN, gel was applied without occlusion for 8 hours. For limb or torso PHN, gel was applied under occlusion for 24 hours. The 16 subjects with cranial PHN reported pain relief significantly favoring local drug application at 30 minutes, 2, 4, and 8 hours. The 23 subjects with torso or limb PHN reported significantly lower pain intensity with local drug application at 8 hours and both pain relief and reduced pain intensity at 24 hours. Remote lidocaine application to mirror-image skin was no different from placebo. No systemic adverse effects were reported and blood levels did not exceed 0.6 microgram/ml. Topical application of 5% lidocaine gel relieves PHN pain by a direct drug action on painful skin.
Collapse
Affiliation(s)
- M C Rowbotham
- Department of Neurology, University of California-San Francisco 94143
| | | | | |
Collapse
|
38
|
Abstract
We studied the analgesic efficacy of an intravenous infusion of lidocaine and morphine in 19 adults with well-established postherpetic neuralgia in a three-session, randomized, double-blind, placebo-controlled trial. Compared with saline placebo, both lidocaine and morphine reduced pain intensity. Reductions in pain did not correlate with side effects produced by the infusions. For morphine, there was a significant correlation between reductions in pain intensity and blood level achieved. In the majority of subjects who reported definite pain relief, allodynia also disappeared. The results show that neuropathic pain can respond to opioids and to systemically administered local anesthetic drugs.
Collapse
Affiliation(s)
- M C Rowbotham
- Department of Neurology, University of California, San Francisco 94143
| | | | | |
Collapse
|
39
|
Vafai A, Wellish M, Gilden DH. Expression of varicella-zoster virus in blood mononuclear cells of patients with postherpetic neuralgia. Proc Natl Acad Sci U S A 1988; 85:2767-70. [PMID: 2833752 PMCID: PMC280080 DOI: 10.1073/pnas.85.8.2767] [Citation(s) in RCA: 58] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Postherpetic neuralgia (PHN), the most frequent complication of varicella-zoster virus (VZV) reactivation, is characterized by pain that persists for greater than 1 mo and often for years after zoster rash. To examine whether PHN might be related to reactivation of VZV, blood mononuclear cells of patients with PHN were tested for the presence of VZV DNA and proteins. VZV DNA was detected in the mononuclear cells of one PHN patient. VZV-specific proteins were detected in mononuclear cells of two acute-varicella patients, one acute zoster patient, and six elderly patients with PHN, but these VZV-specific proteins were not detected in three elderly zoster patients without PHN. Furthermore, pulse-chase experiments revealed further processing or degradation of VZV-specific proteins in the mononuclear cells. These findings strongly suggest that persistence, reactivation, and expression of VZV may result in PHN.
Collapse
Affiliation(s)
- A Vafai
- Departments of Neurology, University of Colorado School of Medicine, Denver 80262
| | | | | |
Collapse
|
40
|
Daragon A, Czernichow P, Courtois H, Pinel B, Le Loët X, Deshayes P. [Fasting and postprandial blood glucose in subjects with crural pain and sciatica]. Rev Rhum Mal Osteoartic 1985; 52:7-11. [PMID: 3158066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
The search for diabetes in a patient with crural neuralgia is well established practice. The prevalence of diabetes in the general population is not known, and studies attempting to demonstrate a relationship between diabetes and radiculopathies have been inconclusive. In the present study, fasting and postprandial blood glucose determinations, as well as 14 other parameters, were analyzed in 88 patients with classical sciatica, 27 with crural neuralgia, and 42 with only back pain. Multidimensional statistical analysis revealed that patients with crural neuralgia were older than those with classical sciatica or only back pain, and that there were no differences in blood glucose regulation. The concept that diabetes is found more frequently in patients with crural neuralgia should be revised, since age appears to be the only factor responsible for changes in glucose regulation.
Collapse
|
41
|
Ohba Y, Matsuoka M, Fuyuno K, Yamamoto K, Nishijima S, Miyaji T. Further studies on hemoglobin Hofu, beta 126 (H 4) Val replaced by Glu, with special reference to its stability. Hemoglobin 1981; 5:89-95. [PMID: 7204097 DOI: 10.3109/03630268108996913] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
|
42
|
Jin T, Taniguchi K, Wakayama S, Tachizaki T, Oyama T. [Effect of trigeminal nerve block on adrenocortical function (author's transl)]. Masui 1980; 29:351-4. [PMID: 7382104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
|
43
|
|
44
|
Danta G. Second phase platelet aggregation induced by adenosine diphosphate in patients with cerebral vascular disease and in control subjects. Thromb Diath Haemorrh 1970; 23:159-69. [PMID: 5420427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
|