Vertebroplastia percutánea en fracturas vertebrales osteoporóticas / Percutaneous vertebroplasty for osteoporotic vertebral fractures

La osteoporosis es una enfermedad sistémica que deteriora la calidad del hueso y su arquitectura. Como consecuencia, predispone a fracturas por fragilidad, entre las cuales las fracturas vertebrales son frecuentes. Estas se asocian a una gran morbimortalidad. La vertebroplastia ha surgido en 1984 como alter-nativa terapéutica para tratar algunos tumores vertebrales y fracturas vertebrales osteoporóticas dolorosas. Este procedimiento consiste en la inyección de cemento guiado por imágenes, para estabilizar la vértebra fracturada y disminuir el dolor. La vertebroplastia puede ser realizada con anestesia local, sedación o anestesia general. La fuga de cemento fuera de la vértebra es una complicación común; sin embargo esto no suele tener traducción clínica y solamente se trata de un hallazgo imagenológico. En este artículo revisaremos las indicaciones, contraindicaciones, la eficacia, controversias y las complicaciones de la vertebroplastia percutánea. (AU)

Osteoporosis is a systemic disease characterized by bone quality deterioration. As a consequence of this deterioration, osteoporosis results in high fracture risk due to bone fragility. Fractures to the spine are common in this scenario, and relate to an increased morbi-mortality. Vertebroplasty emerged in 1984 as an alternative to treat painful vertebral tumors and osteoporotic vertebral fractures. This procedure relies on image guided cement injection to achieve pain relief and strengthen the vertebral body. Vertebroplasty can be performed under local anesthesia, mild sedation, or general anesthesia. Among its complications, cement leakage is common but it is rarely associated with any symptoms and it is usually an imaging finding. In this article, we will review indications and contraindications, effectiveness, controversies and complications related to percutaneous vertebroplasty. (AU)

The P2X7 Receptor, Cathepsin S and Fractalkine in the Trigeminal Subnucleus Caudalis Signal Persistent Hypernociception in Temporomandibular Rat Joints.

Temporomandibular joint (TMJ) is frequently involved with rheumatoid arthritis with a high prevalence that could result in a chronic pain state. Once the disease is established in the joint, the antigen-specific immune reaction initiates a neuro-immune cascade of events that causes sensitization of the central nervous system. This study establishes animal experimental models that evaluate the chronicity of albumin-induced arthritis hypernociception in the TMJ. Antigen-induced arthritis was generated in rats with methylated bovine serum albumin (mBSA) diluted in complete Freund's. Intra-articular injection of mBSA (10 µg/TMJ/week) during 3 weeks resulted in a persistent inflammatory hypernociception which was characterized by an inflammatory episode characterized by the increased of lymphocytes, macrophages and pro-inflammatory interleukins IL-12 and IL-18. The persistent model of inflammatory hypernociception induced by arthritis in the TMJ elicited protein levels of P2X7 receptors, cathepsin S and fractalkine in the trigeminal subnucleus caudalis. Overall, the results of the present work suggest that a persistent inflammatory hypernociception of albumin-induced arthritis in the TMJ leads to the activation of the central nervous system signaling by P2X7/cathepsin S/fractalkine pathway.

Synthetic chalcones as potential tool for acute- and chronic-pain control.

The purpose of this study was to validate the potential anti-hypersensitive activity of two chalcones, (2E)-1-(4-aminophenyl)-3-(4-nitrophenyl)prop-2-en-1-one (ANCh) and N-{4-[(2E)-3-(4-nitrophenyl)prop-2-enoil]phenyl}acetamide (AcANCh), by different models of acute and persistent pain in mice, besides in silico analysis. Molecules computational investigation for prediction of Lipinki's and Veber's rules to determine solubility, % absorption, drug likeness and toxicity liabilities was performed. Male and female C57BL/6 mice (20-30 g, n = 6) were used. Firstly, mice were pre-treated with the compounds ANCh or AcANCh and then submitted to the models of acute hypersensitivity by the intraplantar injection of different phlogistic agents. The mechanical sensitivity was assessed using von Frey hairs (0.6 g). The obtained data shows that both compounds presented important inhibitory effects on mechanical hypersensitivity induced by carrageenan (with oral bioavailability). The anti-hypersensitive effect was also accompanied by the interference in leukocyte migration, interleukin-1ß (IL-1ß) and tumour necrosis factor (TNF) levels reduction and by the absence of unspecific effects. Added to the in vivo results, the in silico analysis presented none violation in Lipinski's or Veber's rules, good probability to cell membrane permeability and oral bioavailability, positive values of drug likeness and few risk of computational toxicity. ANCh partially reduced the hypersensitivity induced by IL-1ß and TNF, epinephrine and prostaglandin E2 (PGE2). AcANCh had similar effect, except for the absent of inhibition in PGE2-injected mice. Both compounds were capable of reducing the mechanical hypersensitivity presented in all persistent models of hypersensitivity (inflammatory pain, chronic nerve constriction and cancer pain), with emphasis for ANCh. These results suggest that both chalcones could represent good strategies for the control of acute and chronic pain, without important side effects. ANCh seems to involve cell migration and cytokines production as the main mechanism, together with interference in PGE2 neuronal sensitization pathway. In vivo and in silico analyses reinforce the potential characteristics of the compounds to become future drugs.

Personality, coping and atypical facial pain. Case reports / Personalidade, enfrentamento e dor facial atípica. Relato de casos

ABSTRACT BACKGROUND AND OBJECTIVES: Idiopathic facial pain is a chronic condition with unknown etiology and pathophysiology. Its diagnostic criteria depend on the exclusion of any somatic cause of orofacial pain. Several studies have investigated anxiety and depression, but there is a lack of publications about personality. The objective of this study was to describe three cases of patients with idiopathic facial pain that had their temperament and character evaluated in order to verify the relation between the findings with pain behavior and pain characteristics. The instruments used were a free interview and the Temperament and Character Inventory. CASE REPORTS: Case 1 was proactive and had high scores of cooperativity and self-transcendence correspondent to the well-coping behavior. On the other side, cases 2 and 3 showed similarities about their harm avoidance, novelty seeking and poor coping, correspondent to a self-protective insecure personality. CONCLUSION: These cases show the importance of personality assessment in order to determine coping strategies in complex chronic facial pain such as idiopathic facial pain.

RESUMO JUSTIFICATIVA E OBJETIVOS: Dor facial idiopática persistente é uma condição crônica cujas etiologia e fisiopatologia permanecem obscuras. Os critérios diagnósticos dependem da exclusão de todas as possíveis causas somáticas de dor orofacial. Vários estudos investigaram frequentes comorbidades psiquiátricas como ansiedade e depressão, mas há carência de estudos que tenham observado aspectos de personalidade nesses doentes. O objetivo deste estudo foi descrever três casos de pacientes com dor facial idiopática persistente que foram avaliados quanto a traços de personalidade e de caráter, bem como a associação desses traços com as características da dor e o comportamento doloroso. Os instrumentos utilizados foram a entrevista livre e o Inventário de Caráter e Temperamento de Cloninger. RELATO DOS CASOS: O caso 1 apresentava traços de proatividade e altos índices de cooperatividade e autotranscendência, correspondentes com seu perfil de bom enfrentamento. Por outro lado, os casos 2 e 3 apresentaram similaridades quanto à evitação de dor, busca por novidades e enfrentamento pobre, o que correspondeu a uma personalidade insegura e autoprotetora. CONCLUSÃO: Esses casos mostram a importância de abordar a personalidade do paciente para que estratégias de enfrentamento adequadas sejam estabelecidas para a dor facial crônica complexa.

Dor crônica pós-operatória: relato de casos / Postoperative chronic pain: case reports.

JUSTIFICATIVA E OBJETIVOS: A prevalência da dor crônica pós-operatória é alta e envolve vários mecanismos relacionados ao paciente e ao procedimento cirúrgico realizado. O objetivo deste estudo foi relatar dois casos de dor crônica pós-operatória em tipos diferentes de procedimento cirúrgicos.RELATO DOS CASOS: Caso 1: Paciente do sexo masculino, 38 anos, submetido a tratamento cirúrgico de fratura fechada de punho esquerdo. Evoluiu com dor contínua, de forte intensidade, queimação e choque, nos 1º e 2º quirodáctilos, sendo reoperado após 30 e 60 dias, devido à dor. Houve piora do quadro doloroso e dificuldade à movimentação do punho, com dor em queimação no antebraço e mão esquerdos, de forte intensidade, contínua, associada a episódios dolorosos paroxísticos iniciados na cicatriz cirúrgica irradiando para todo o antebraço e mão. A telerradiografia do punho esquerdo mostrou correção anatômica da fratura e a eletroneuromiografia (ENM), lesão do nervo radial superficial. Foi feito bloqueio do gânglio estrelado (BGE), amitriptilina (25 mg/dia) e alongamentos do punho, antebraço e braço que proporcionou alivio parcial da dor. Caso 2: Paciente do sexo feminino, 63 anos, submetida à blefaroplastia superior e inferior bilateral com objetivo estético, evoluiu com dor periorbitária, em queimação e choque. Na primeira avaliação, a paciente relatou sentir, desde o pós-operatório imediato, dor em queimação, contínua de moderada intensidade, que se exacerbava ao toque e ao frio e dor em choque, de moderada intensidade agravada pelo ato de piscar. Tratada com gel tópico de amitriptilina a 2%, duas vezes ao dia com alívio completo da dor em queimação.CONCLUSÃO: Dor iniciada no pós-operatório imediato de forte intensidade com lesão nervosa confirmada no primeiro caso e presumida no segundo, alerta para a importância de medidas preventivas cirúrgicas e anestésicas para diminuir a ocorrência da dor crônica pós-operatória.

BACKGROUND AND OBJECTIVES: Postoperative chronic pain prevalence is high and involves several mechanisms related to patients and to surgical procedures. This study aimed at reporting two postoperative chronic pain cases after different surgical procedures.CASE REPORTS: Case 1: Male patient, 38 years old, submitted to surgical treatment of left wrist closed fracture. He evolved with continuous and severe pain, burning and shock in first and second fingers being re-operated after 30 and 60 days due to pain. There has been worsening of pain and difficulty to move the wrist, with severe burning pain in left forearm and hand, associated to paroxysmal painful episodes starting at the surgical scar and irradiating to the whole forearm and hand. Left wrist teleradiography showed anatomic correction of fracture and electroneuromyography (ENM) should superficial radial nerve injury. Stellate ganglion was blocked (SGB), amitriptyline (25 mg/day) and wrist, forearm and arm elongation, which provided partial pain relief. Case 2: Female patient, 63 years old, submitted to bilateral upper and lower cosmetic blepharoplasty, who evolved with periorbital burning and shock pain. During the first evaluation patient reported feeling moderate burning pain since the immediate postoperative period, which was exacerbated by touch and cold, and moderate shock pain worsened by blinking. Patient was treated with amitriptyline topic gel at 2% twice a day with total burning pain relief. CONCLUSION: Severe pain started in the immediate postoperative period with confirmed nervous injury in the first case and presumed nervous injury in the second, calling the attention to the importance of surgical and anesthetic preventive measures to decrease the incidence of postoperative chronic pain.