RESUMO
Subcutaneous atrophy is a known complication of steroid injections. Excellent results with fat grafting for the treatment of steroid atrophy have been documented. However, the benefit of treating steroid-induced subcutaneous atrophy in an extremity diagnosed with complex regional pain syndrome (CRPS) has not been described. CRPS, known formerly as reflex sympathetic dystrophy or RSD, causalgia, or reflex neurovascular dystrophy, is a severe, progressive musculoskeletal pain syndrome characterized by pain which is disproportionate to the severity of the inciting event, edema, or skin changes. Common treatment modalities include pharmacotherapy, physical therapy, and nerve blocks-each therapy producing varying results. We present a literature review of CRPS and the case of a 15-year-old female who developed CRPS of the left lower leg after arthroscopic debridement with retrograde drilling of an osteochondral lesion. Steroid atrophy of the involved area following a saphenous nerve block complicated the patient's treatment course. The area of atrophy was treated with autologous fat grafting. Following the adipose injection procedure, the patient experienced almost complete resolution of her CPRS-associated pain symptoms, along with improved cosmetic appearance of the area.
Assuntos
Tecido Adiposo/transplante , Atrofia/terapia , Causalgia/terapia , Cicatriz/terapia , Adolescente , Corticosteroides/efeitos adversos , Atrofia/induzido quimicamente , Causalgia/induzido quimicamente , Cicatriz/induzido quimicamente , Feminino , Humanos , Nervos Periféricos/fisiopatologia , Resultado do TratamentoRESUMO
Topical 8 % capsaicin is an established therapeutic option for the treatment of peripheral neuropathic pain. In accordance with the internationally accepted definition, complex regional pain syndrome (CRPS) type II is a form of neuropathic pain so that capsaicin plasters represent a treatment option. However, for the treatment of CRPS it is recommended that painful stimuli should be avoided but capsaicin induces a strong nociceptive stimulation and so its use is at present controversial. We report on the course of such an application in a patient who developed CRPS type II with intractable neuropathic pain after hallux surgery. As a result of a single treatment with capsaicin a pronounced recurrence developed with central nervous symptoms.
Assuntos
Capsaicina/administração & dosagem , Capsaicina/efeitos adversos , Causalgia/induzido quimicamente , Causalgia/tratamento farmacológico , Hallux/cirurgia , Complicações Pós-Operatórias/induzido quimicamente , Complicações Pós-Operatórias/tratamento farmacológico , Doença Aguda , Administração Cutânea , Adulto , Anestesia Epidural , Causalgia/diagnóstico , Causalgia/cirurgia , Terapia Combinada , Relação Dose-Resposta a Droga , Feminino , Seguimentos , Fidelidade a Diretrizes , Humanos , Bloqueio Nervoso , Medição da Dor/efeitos dos fármacos , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/cirurgia , Recidiva , Reoperação , Inquéritos e Questionários , Aderências Teciduais/diagnóstico , Aderências Teciduais/cirurgia , Dedos do Pé/inervaçãoRESUMO
Morphological features of TRPV1(+)-, SP(+)-, CGRP(+)-, NF200(+)-neurons has been studied in thoracic spinal ganglions in 3-month-old rats under chemical deafferentation. The results have shown that from 6.5 up to 41.3% of ganglionic neurons of control group had markers mentioned above. The heterogeneity of nociceptive neurons in control group was kept in capsaicin-treated animals. In both groups, TRPV1(+)-neurons were prevailed, populations of SP(+)-, CGRP(+)- and NF200(+)-neurons formed smaller groups. Sensitivity to capsaicin was shown in largest neurons in each population; neurons in experimental group had smaller cross-sectional area, particularly in group of TRPV1(+)-neurons.
Assuntos
Capsaicina/farmacologia , Causalgia/induzido quimicamente , Gânglios Espinais/metabolismo , Neurônios Aferentes/metabolismo , Animais , Peptídeo Relacionado com Gene de Calcitonina/metabolismo , Gânglios Espinais/efeitos dos fármacos , Masculino , Proteínas de Neurofilamentos/metabolismo , Neurônios Aferentes/citologia , Neurônios Aferentes/efeitos dos fármacos , Ratos , Ratos Sprague-Dawley , Canais de Cátion TRPV/metabolismoRESUMO
Galanin is a 29-aa neuropeptide with a complex role in pain processing. Several galanin receptor subtypes are present in dorsal root ganglia and spinal cord with a differential distribution. Here, we describe a generation of a specific galanin R2 (GalR2) agonist, AR-M1896, and its application in studies of a rat neuropathic pain model (Bennett). The results show that in normal rats mechanical and cold allodynia of the hindpaw are induced after intrathecal infusion of low-dose galanin (25 ng per 0.5 microl/h). The same effect is seen with equimolar doses of AR-M1896 or AR-M961, an agonist both at GalR1 and GalR2 receptors. In allodynic Bennett model rats, the mechanical threshold increased dose-dependently after intrathecal injection of a high dose of AR-M961, whereas no effect was observed in the control or AR-M1896 group. No effect of either of the two compounds was observed in nonallodynic Bennett model rats. These data indicate that a low dose of galanin has a nociceptive role at the spinal cord level mediated by GalR2 receptors, whereas the antiallodynic effect of high-dose galanin on neuropathic pain is mediated by the GalR1 receptors. Thus, a selective GalR1 agonist may be used to treat neuropathic pain.
Assuntos
Analgésicos não Narcóticos/uso terapêutico , Causalgia/fisiopatologia , Galanina/farmacologia , Galanina/fisiologia , Hiperestesia/fisiopatologia , Proteínas do Tecido Nervoso/fisiologia , Fragmentos de Peptídeos/farmacologia , Isoformas de Proteínas/fisiologia , Receptores de Neuropeptídeos/fisiologia , Ciática/fisiopatologia , Medula Espinal/fisiopatologia , Analgésicos não Narcóticos/administração & dosagem , Analgésicos não Narcóticos/farmacologia , Animais , Causalgia/induzido quimicamente , Causalgia/tratamento farmacológico , Temperatura Baixa/efeitos adversos , Relação Dose-Resposta a Droga , Galanina/administração & dosagem , Galanina/química , Galanina/uso terapêutico , Galanina/toxicidade , Gânglios Espinais/química , Gânglios Espinais/efeitos dos fármacos , Membro Posterior/inervação , Hiperestesia/induzido quimicamente , Hiperestesia/tratamento farmacológico , Hiperestesia/etiologia , Bombas de Infusão Implantáveis , Masculino , Modelos Animais , Proteínas do Tecido Nervoso/agonistas , Limiar da Dor/efeitos dos fármacos , Fragmentos de Peptídeos/química , Isoformas de Proteínas/agonistas , Ratos , Ratos Sprague-Dawley , Receptores de Galanina , Receptores de Neuropeptídeos/agonistas , Nervo Isquiático/lesões , Ciática/tratamento farmacológico , Ciática/etiologia , Medula Espinal/química , Estresse Mecânico , Especificidade por SubstratoRESUMO
A double-blind clinical trial compared the efficacy and safety of two popular carbamide peroxide tooth whitening products with a placebo agent. After six weeks, both study products produced significantly whiter teeth than did the placebo agent.
Assuntos
Peróxidos/efeitos adversos , Clareamento Dental/efeitos adversos , Ureia/análogos & derivados , Adulto , Peróxido de Carbamida , Causalgia/induzido quimicamente , Método Duplo-Cego , Combinação de Medicamentos , Feminino , Humanos , Masculino , Palato/efeitos dos fármacos , Paladar/efeitos dos fármacos , Ureia/efeitos adversosRESUMO
The syndrome of "painful legs and moving toes" is characterised by spontaneous causalgic pain in the lower extremities associated with peculiar involuntary movements of the toes and feet. It has been observed after a variety of lesions affecting the posterior nerve roots, the spinal ganglia and the peripheral nerves. The pathophysiology of the syndrome is unknown. I report a patient who developed the syndrome during treatment for schizophrenia with the antipsychotic agent molindone hydrochloride. The patient's response to the combination of clonazepam and baclofen suggests that the pathophysiology of the "painful legs and moving toes" may be linked to impairment of spinal serotonergic and GABA functions.
Assuntos
Baclofeno/uso terapêutico , Causalgia/tratamento farmacológico , Clonazepam/uso terapêutico , Discinesia Induzida por Medicamentos/tratamento farmacológico , Molindona/efeitos adversos , Causalgia/induzido quimicamente , Causalgia/fisiopatologia , Discinesia Induzida por Medicamentos/etiologia , Discinesia Induzida por Medicamentos/fisiopatologia , Feminino , Humanos , Perna (Membro) , Pessoa de Meia-Idade , Molindona/uso terapêutico , Esquizofrenia/complicações , Esquizofrenia/tratamento farmacológico , Serotonina/fisiologia , Síndrome , Dedos do Pé , Ácido gama-Aminobutírico/fisiologiaRESUMO
Chemonucleolysis with chymopapain is accepted by many surgeons as a reasonable alternative to lumbar diskectomy for the treatment of lumbar disk disease. Approximately 70 to 75 per cent of carefully selected patients are successfully treated following this therapy, but extreme care must be exercised for precise needle placement and prompt and vigorous management of major allergic reactions. Methods to avoid major complications and their management, should they occur, are discussed.
Assuntos
Quimopapaína/uso terapêutico , Endopeptidases/uso terapêutico , Deslocamento do Disco Intervertebral/tratamento farmacológico , Adolescente , Adulto , Idoso , Anafilaxia/etiologia , Anafilaxia/prevenção & controle , Anestesia Local , Causalgia/induzido quimicamente , Hemorragia Cerebral/induzido quimicamente , Quimopapaína/efeitos adversos , Droperidol , Fentanila , Humanos , Injeções , Embolia e Trombose Intracraniana/etiologia , Pessoa de Meia-Idade , Neuroleptanalgesia , Paraplegia/induzido quimicamente , Pré-MedicaçãoRESUMO
In the first of a two-part study, the authors review the known biochemical, pharmacological, toxicological, and experimental data concerning chymopapain and the intervertebral disc. They describe the action of this proteolytic enzyme, which apparently disrupts the protein mucopolysaccharide component of disc material, most marked in the nucleus pulposus. A rapid conversion to collagen causes a loss of disc space height; toxicity appears to result from alteration of bonding between capillary endothelial cells that in turn produces hemorrhage. Part 2 reviews significant reported results and complications of clinical chemonucleolysis.
Assuntos
Quimopapaína/uso terapêutico , Endopeptidases/uso terapêutico , Deslocamento do Disco Intervertebral/tratamento farmacológico , Anafilaxia/etiologia , Animais , Aracnoidite/induzido quimicamente , Catálise , Gatos , Causalgia/induzido quimicamente , Fenômenos Químicos , Química , Quimopapaína/efeitos adversos , Quimopapaína/toxicidade , Erros de Diagnóstico , Cães , Hipersensibilidade a Drogas/etiologia , Seguimentos , Glicosaminoglicanos , Cobaias , Humanos , Inflamação/induzido quimicamente , Injeções Intraperitoneais , Injeções Intravenosas , Injeções Espinhais , Disco Intervertebral/efeitos dos fármacos , Deslocamento do Disco Intervertebral/diagnóstico , Coelhos , Doenças da Medula Espinal/induzido quimicamente , Fatores de TempoRESUMO
Chymopapain chemonucleolysis was performed on 100 patients with primary lumbar intervertebral disc disease. The results were compared with those of 174 patients who underwent laminotomy, foraminotomy, and discectomy. Primary lumbar intervertebral disc disease was arbitrarily divided into degenerative, complex, previous surgical, and simple disc syndromes. No difference was seen between chemonucleolysis and surgery in the first three divisions; between 55 percent and 60 per cent of patients responded successfully to treatment. In the simple disc division 89 per cent of the surgical and 60 per cent of the chemonucleolysis patients had successful results.