Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 27
Filtrar
Mais filtros










Base de dados
Intervalo de ano de publicação
1.
Schmerz ; 2023 Oct 20.
Artigo em Alemão | MEDLINE | ID: mdl-37864020

RESUMO

BACKGROUND: Multimodal pain therapy usually take place in the context of group therapy lasting several weeks and is based on a generally activating approach. Due to the specificity of stress intolerance with postexertional malaise (PEM) in patients with postviral syndromes, physical as well as psychological overload must be urgently avoided in these cases; however, these aspects can only be insufficiently considered in current medical pain therapy concepts. METHODS: Summary of the current literature and presentation of clinical characteristics as well as presentation of a model project for a multimodal pain therapy in postviral syndromes with PEM. MODEL CONCEPT: The presented model project describes a day clinic treatment setting for interdisciplinary multimodal pain therapy adapted to the individual resilience with minimization of the risk of strain-induced deterioration of the condition.

2.
Chronobiol Int ; 40(4): 400-406, 2023 04.
Artigo em Inglês | MEDLINE | ID: mdl-36852529

RESUMO

Multidisciplinary pain treatment programs (MPTP) have been considered to be the most effective treatment of chronic pain. In this study, we analyzed the influence of seasons on the outcome of chronic pain patients undergoing MPTP. Therefore, a prospective, observational trial was conducted in patients with chronic pain undergoing a 5-week interdisciplinary treatment program. Psychological stabilization (measured by ADS - Allgemeine Depressionsskala) and pain levels (measured by NRS - numeric rating scale) were considered as primary endpoints. As a result of this study, we could show that chronic pain patients (exempt patients with chronic headache) showed a highly significant better improvement in terms of ADS after MPTP when participating in autumn (coefficient: -11.67, p = .004). Patients treated during winter showed a tendency towards a better improvement in ADS scores (coefficient: -6.89, p = .051). These effects were not found in patients suffering from chronic headache. Finally, patients participating in MPTPs during summer, autumn, and winter presented a tendency of higher reduction in pain scores when compared to patients participating in spring. In conclusion, the effect of MPTPs in terms of psychological stabilization is considered to be best during autumn. This should be therefore considered in planning an MPTP in all patients who do not need immediate psychological stabilization. The treatment effect of MPTP on pain seems not being dependent on a specific season.


Assuntos
Dor Crônica , Transtornos da Cefaleia , Humanos , Dor Crônica/terapia , Ritmo Circadiano , Estudos Prospectivos , Estações do Ano , Resultado do Tratamento
3.
Chronic Illn ; 19(3): 635-645, 2023 09.
Artigo em Inglês | MEDLINE | ID: mdl-35787196

RESUMO

OBJECTIVES: Interdisciplinary treatment programmes are the gold standard for patients suffering from chronic pain. However, several patient-related factors seem to influence the patients' outcome. The aim of our study was to inquire whether patients with personality disorders (PD) might benefit less from an interdisciplinary treatment programme compared to patients without PD. METHODS: A prospective, observational study with chronic pain patients attending a 5-week interdisciplinary treatment programme was performed. Main outcome parameters were psychological stabilization and pain intensity before and after the programme. RESULTS: Out of the 104 included patients, 71 (68.3%) showed personality accentuations and 16 (15.4%) were diagnosed with PDs. PDs were mostly classified as histrionic, followed by borderline and narcistic personality. Patients diagnosed with histrionic accentuation showed a significantly better treatment response in terms of pain. Reduction in ADS (Allgemeine Depressionsskala - depression scale) was 3.4 in patients with PD and 11.1 in those without PD. Borderline patients showed a significant increase of ADS (by 2.0; p < 0.05) after programme completion. DISCUSSION: Patients with chronic pain and personality accentuations or disorder only showed a slightly different outcome after interdisciplinary treatment programme and should therefore not be excluded from these programmes. Registered at German Clinical Trials Register (DRKS-ID: DRKS00015141).


Assuntos
Dor Crônica , Humanos , Dor Crônica/terapia , Estudos Prospectivos , Transtornos da Personalidade/complicações , Transtornos da Personalidade/terapia , Transtornos da Personalidade/diagnóstico
4.
J Med Ethics ; 48(9): 630-636, 2022 09.
Artigo em Inglês | MEDLINE | ID: mdl-34021060

RESUMO

Due to the spread of COVID-19, a key challenge was to reduce potential staff shortages in the healthcare sector. Besides recruiting retired healthcare workers, medical students were considered to support this task. Commitment of medical students in Germany during the COVID-19 pandemic was evaluated using an online survey, with particular focus on their burdens and anxieties. This survey was distributed to students within a 2-week period in April and May 2020. Ultimately, 1241 participants were included in the analysis. During the pandemic, 67.9% (65.3% to 70.5%) of the participants reported that they had volunteered. Furthermore, 88.9% (86.9% to 90.5%) stated that they were against compulsory recruitment in this context. Students who volunteered (committed students) had a significantly lower anxiety index than non-committed students. Additionally, students were more concerned about infecting other patients and relatives than themselves. Higher levels of anxiety were related to lower levels of commitment. A mandatory assignment during the pandemic was rejected by the students and does not seem to be necessary due to the large number of volunteers.


Assuntos
COVID-19 , Estudantes de Medicina , COVID-19/epidemiologia , Humanos , Pandemias , Inquéritos e Questionários , Voluntários
5.
J Cardiovasc Surg (Torino) ; 62(4): 391-398, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-33565745

RESUMO

BACKGROUND: Cardiopulmonary bypass during cardiac surgery is associated with metabolic changes after operation and results inter alia in increased levels of lactate and bilirubin. Since prediction of the course after operation has become very important for the management of an ICU and the patients themselves, we evaluated easily assessable markers (lactate and bilirubin), regarding their potential to predict mortality 90 days after surgery and the length of stay in ICU. METHODS: All patients within a period of five years undergoing cardiac surgery were enrolled in the study. Among others peak levels of lactate and bilirubin within 48 hours after operation were recorded. A Cox proportional hazard model as well as a logistic regression model were used to predict mortality or rather length of stay in ICU. RESULTS: Increased levels of bilirubin and lactate were associated with a significantly increase in mortality and length of stay in ICU (in a concentration-related manner). Interestingly, creatinine serum levels before operation showed a similar performance. CONCLUSIONS: Three easily assessable and cheap laboratory parameters (bilirubin, lactate, and creatinine) are useful to predict 90-day mortality and length of stay in ICU. These findings might be helpful to give patients a reliable prediction about short and mid-term-survival and to improve the management of an ICU.


Assuntos
Bilirrubina/sangue , Procedimentos Cirúrgicos Cardíacos , Doenças Cardiovasculares/cirurgia , Unidades de Terapia Intensiva , Ácido Láctico/sangue , Complicações Pós-Operatórias/sangue , Idoso , Biomarcadores/sangue , Doenças Cardiovasculares/sangue , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico
6.
Schmerz ; 34(5): 431-434, 2020 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-32820359

RESUMO

Due to the COVID-19 pandemic, elective medical services have had to be reduced to a minimum, which has also affected care in pain medicine. Following these drastic cutbacks, a cautious resumption of elective care is planned. This also applies to the delivery of inpatient and day-care interdisciplinary multimodal pain therapy (IMPT). Since the majority of pain medicine centers have been closed to date, the question has arisen as to whether a resumption of regular care can be easily provided under the required protective measures. To answer this question, the authors conducted a survey among patients that were in a position to make a direct comparison between IMPT under normal conditions as well as under the currently required protective measures. The survey recorded the level of disruption caused by the different protective measures in the various treatment modules. An evaluation of the questionnaires, which were completed by two patient groups and all therapists involved, revealed that interdisciplinary multimodal pain therapy is possible without significant impairments even under the required protective measures. In particular, wearing protective masks proved to be the protective measure with the greatest negative impact. However, options like the use of protective visors or relocating treatment modules to the outdoors offer practicable alternative solutions for protection. Both patient and therapist satisfaction was high despite these constraints, and personal concern regarding possible infection low.


Assuntos
Infecções por Coronavirus/epidemiologia , Manejo da Dor/métodos , Pneumonia Viral/epidemiologia , Betacoronavirus , COVID-19 , Humanos , Dor , Pandemias , SARS-CoV-2 , Inquéritos e Questionários
7.
Nicotine Tob Res ; 22(1): 111-117, 2020 01 27.
Artigo em Inglês | MEDLINE | ID: mdl-30247701

RESUMO

INTRODUCTION: Smoking is associated with several diseases and affects the immune system. Recently, published data demonstrate an involvement of T helper 17 cells (Th17) and regulatory T cells (Tregs) in the pathogenesis of chronic pain and pain intensity. The role of these T-cell subsets in smoking patients with chronic pain is nebulous so far. We therefore analyzed Th17 cells and Tregs in smokers and nonsmokers with chronic pain. METHODS: Analyses of T-cell subsets, mRNA expression and T-cell related cytokine profiles were done in 44 patients with chronic pain. Twenty-two of these patients were smokers. Numbers of T-cell subsets were quantified by flow cytometry. mRNA expression of the Th17- (RAR-related orphan receptor gamma) and Treg (forkhead box protein P3)-specific transcription factors was determined by quantitative real-time PCR, and levels of cytokines were measured by Human Cytokine Multiplex Immunoassay. RESULTS: Compared to nonsmokers, smokers showed significantly enhanced pain levels. On cellular basis, the number of pro-inflammatory Th17 cells (smokers: 2.2 ± 2.5% vs. nonsmokers: 0.5 ± 0.4%; p = .04) was increased, whereas the number of anti-inflammatory Tregs (smokers: 2.5 ± 0.9% vs. nonsmokers: 3.1 ± 1.1%; p = .02) was significantly decreased, resulting in an altered Th17/Treg ratio (Th17/Treg ratio: 0.9 ± 1.0 in smokers vs. 0.2 ± 0.1 in nonsmokers; p < .01). These findings were confirmed by quantitative real-time PCR. Analyses of cytokines revealed only marginal changes. CONCLUSIONS: In patients with chronic pain, smoking is associated with enhanced pain levels together with an imbalance of the Th17/Treg ratio. The shift of the Th17/Treg ratio toward inflammation may explain in part the increased pain intensity in these patients. IMPLICATIONS: Smoking is associated with increased pain levels and a pro-inflammatory Th17/Treg shift. The altered Th17/Treg ratio in smoking patients with chronic pain may partly explain their increased pain intensity. GERMAN CLINICAL TRIAL REGISTER (DRKS): Registration Trial DRKS00005954.


Assuntos
Dor Crônica/imunologia , Inflamação/imunologia , Fumar/efeitos adversos , Linfócitos T Reguladores/imunologia , Células Th17/imunologia , Dor Crônica/induzido quimicamente , Dor Crônica/epidemiologia , Citocinas/metabolismo , Feminino , Alemanha/epidemiologia , Humanos , Incidência , Inflamação/induzido quimicamente , Inflamação/epidemiologia , Masculino , Pessoa de Meia-Idade , Prognóstico , Linfócitos T Reguladores/efeitos dos fármacos , Células Th17/efeitos dos fármacos
8.
Pain ; 161(2): 266-273, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31592999

RESUMO

Insufficient perioperative pain treatment is known as a highly predictive risk factor for the development of chronic postoperative pain. Remifentanil is an ultrashort-acting opioid that provides quick and efficient analgesia but is associated with the induction of opioid-induced hyperalgesia. Despite these well-known characteristics, this substance is being increasingly used in anesthesia and in a variety of medical fields, such as intensive-care medicine and obstetrics. The aim of our study was to reveal whether remifentanil influences postoperative pain, the requirement for postoperative analgesics, and requirement of antiemetics (as indirect indicator of postoperative nausea and vomiting), as well as the effects on time to extubation and length of stay in the postanesthesia care unit in daily clinical routine. From an electronic medical records database of 55,693 anesthesias, we analyzed data from all patients receiving intraabdominal surgery (visceral, gynecological, and urological) under general anesthesia or combined general-epidural anesthesia by propensity score matching. The administration of remifentanil was associated with higher postoperative pain scores despite a higher requirement of postoperative analgesics. Additional epidural analgesia was not able to avoid this finding. The intraoperative use of remifentanil is associated with a deterioration of pain levels and postoperative analgesic requirement, wherefore the potential benefit of this substance seems to be outweighed by its potential disadvantages. Especially in operative procedures in which high postoperative pain scores are expected, the unreflective use should be critically questioned.


Assuntos
Analgésicos Opioides/uso terapêutico , Cuidados Intraoperatórios/métodos , Dor Pós-Operatória/fisiopatologia , Náusea e Vômito Pós-Operatórios/epidemiologia , Remifentanil/uso terapêutico , Acetaminofen/uso terapêutico , Adulto , Idoso , Analgésicos/uso terapêutico , Anti-Inflamatórios não Esteroides/uso terapêutico , Antieméticos/uso terapêutico , Procedimentos Cirúrgicos do Sistema Digestório , Dipirona/uso terapêutico , Feminino , Procedimentos Cirúrgicos em Ginecologia , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Dor Pós-Operatória/tratamento farmacológico , Pirinitramida/uso terapêutico , Náusea e Vômito Pós-Operatórios/tratamento farmacológico , Sala de Recuperação/estatística & dados numéricos , Procedimentos Cirúrgicos Urológicos
9.
J Neurol ; 266(12): 3167-3170, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31686187

RESUMO

INTRODUCTION: Although chronic low back pain (CLBP) is one of the most common pain syndromes, up to now, clear pathophysiological causes or specific treatment options are missing. Medication-overuse has been associated with chronic headache, but never with CLBP. HYPOTHESIS: Based on several similarities between CLBP and Medication-Overuse Headache (MOH), we hypothesized that medication-overuse might contribute to CLBP as well, maybe even as an own entity. Might there be something like Medication-Overuse Backpain (MOB)? METHODS: We substantiate our hypothesis with a preliminary case-series analyzing five patients suffering from CLBP with a marked medication-overuse. In these patients, a stepwise analgesic withdrawal was recommended. RESULTS: Within 6 months of recruitment, five patients fulfilled the inclusion criteria and successfully completed discontinuation of their medication. All patients reported noticeable pain relief, despite the discontinuation of their analgesics. Withdrawal was well tolerated in all cases. CONCLUSIONS: Considering our results, the described withdrawal method seems to be a simple and safe method to achieve pain reduction while simultaneously preventing organ damage. Despite the preliminary character of our results, our hypothesis might stimulate a new understanding of CLBP's pathophysiology.


Assuntos
Analgésicos não Narcóticos/uso terapêutico , Dor nas Costas , Uso Indevido de Medicamentos , Idoso , Dor nas Costas/tratamento farmacológico , Dor nas Costas/epidemiologia , Dor nas Costas/etiologia , Dor Crônica/tratamento farmacológico , Dor Crônica/epidemiologia , Dor Crônica/etiologia , Feminino , Transtornos da Cefaleia Secundários , Humanos , Masculino , Pessoa de Meia-Idade
10.
Inflamm Res ; 68(1): 1-6, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30155690

RESUMO

The aim of this study was to investigate T-cell subsets and immunomodulatory factors in patients with complex regional pain syndrome (CRPS). We found decreased numbers of pro-inflammatory Th17 cells in patients with CRPS as compared to healthy volunteers. The expression of Th17 related RORγT mRNA was also significantly decreased. Patients with CRPS showed an increased proportion of CD39+ Tregs. CD39 is a known inhibitor of Th17 cell differentiation. Systemic cytokine levels were almost unchanged in patients with CRPS. These findings suggest that the decrease in Th17 cells in CRPS is regulated by an increase in CD39+ Tregs and that this anti-inflammatory T-cell shift may be a mechanism to control inflammation in CRPS. GERMAN CLINICAL TRIAL REGISTER: Registration Trial DRKS00005954.


Assuntos
Apirase/imunologia , Síndromes da Dor Regional Complexa/imunologia , MicroRNAs/imunologia , Linfócitos T Reguladores/imunologia , Células Th17/imunologia , Adulto , Idoso , Síndromes da Dor Regional Complexa/sangue , Citocinas/sangue , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Membro 3 do Grupo F da Subfamília 1 de Receptores Nucleares/imunologia , Medição da Dor , Adulto Jovem
11.
Curr Opin Anaesthesiol ; 32(1): 86-91, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30520741

RESUMO

PURPOSE OF REVIEW: Chronic noncancer pain is an increasing problem in elderly because of rising life expectancy together with an increase of potentially painful medical conditions. Concomitantly, adequate treatment of elderly is often limited by coexisting diseases and polypharmacy.This review summarizes the most important specifics presented by elderly patients and discusses the pharmacological and nonpharmacological options of pain management. RECENT FINDINGS: A comprehensive pain assessment is a prerequisite for effective pain management. However, this can be a major challenge in patients who are unable to communicate adequately, that is, in patients with dementia. A recently developed electronic tool assessing automated facial expression and clinical behavioral indicators may help to solve this problem. The discussion about benefits and harms of opioids in elderly goes on. Although some authors underline the lack of efficacy together with the potential problems, such as, abuse, others report a beneficial effect in terms of pain relief, functional activities and disability. In addition, opioids have become an important treatment option in patients with restless legs syndrome. Various topical treatment options (i.e. capsaicin patch) and nonpharmacological interventions have been proven to be beneficial in elderly. SUMMARY: Adequate pain management of elderly patients constitutes numerous pharmacological options including nonopioids, opioids, coanalgesics and topical agents. Due to age-related characteristics, all systemic analgesics have to be given very cautiously ('start low, go slow'). Whenever possible, treatment should be performed as a multimodal approach based on the biopsychosocial model of chronic pain.


Assuntos
Analgésicos não Narcóticos/administração & dosagem , Analgésicos Opioides/efeitos adversos , Dor Crônica/tratamento farmacológico , Manejo da Dor/métodos , Medição da Dor/métodos , Administração Tópica , Fatores Etários , Idoso , Envelhecimento/fisiologia , Capsaicina/administração & dosagem , Dor Crônica/diagnóstico , Humanos , Manejo da Dor/efeitos adversos , Adesivo Transdérmico , Resultado do Tratamento
12.
Ann Palliat Med ; 6(Suppl 1): S90-S94, 2017 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-28595427

RESUMO

In advanced stages, most cancer patients suffer from pain which can usually be well controlled following the World Health Organization (WHO) level scheme. While the majority of patients report adequate pain relief by strong opioids (WHO III), some require an opioid rotation. Despite the existence of conversion tables, these rotations mea lead to inadequate pain control or life threatening events. Here, we report about a patient with urothelial cell carcinoma presenting in our Department of Pain Medicine with massive pain aggravation up to NRS values of 10/10 despite administration of the highest dose of intravenously applied hydromorphone. After a small single dose of the far less potent opioid piritramide with exceptionally good response, we conducted a stepwise opioid rotation from hydromorphone to piritramide within one week without any signs of abstinence or withdrawal. After the opioid rotation, we discharged the patient nearly free of pain with piritramide doses far less than equianalgesic dose tables would have recommended. Our report impressively points out that even after long-term intravenous application of highly potent opioids, new titrations are necessary for rotation to avoid overdosage and discusses several mechanisms underlying individual response to different opioids.


Assuntos
Analgésicos Opioides/uso terapêutico , Hidromorfona/uso terapêutico , Dor Intratável/prevenção & controle , Neoplasias Uretrais , Analgésicos Opioides/administração & dosagem , Relação Dose-Resposta a Droga , Feminino , Humanos , Hidromorfona/administração & dosagem , Infusões Intravenosas , Pessoa de Meia-Idade , Manejo da Dor , Medição da Dor
13.
Biomark Med ; 11(3): 265-276, 2017 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-28240097

RESUMO

AIM: Pain therapy is strongly guided by patients' self-reporting. However, when self-reporting is not an option, pain assessment becomes a challenge and may lead to undertreatment of painful conditions. Pain is a complex and multifactorial phenomenon. Recent work has connected pain pathophysiology also with the inflammatory system. We therefore hypothesized that pain intensity could be predicted by cytokine-levels. PATIENTS & METHODS: In this observational, single-center study, we investigated 30 serum cytokines to predict pain intensity in a screening/follow-up set of 95 chronic pain patients and controls. We then prospectively validated soluble intercellular adhesion molecule-1 (sICAM-1)'s discriminatory capability (n = 21). RESULTS & CONCLUSION: sICAM-1 was significantly associated with patient-reported pain intensity and yielded differential serum levels in patients of varying degrees of pain intensity. Changes in pain ratings over time correlated with changes in sICAM-1 levels. Our findings suggest the possibility of a clinical use of sICAM-1 as a potential biomarker for pain intensity.


Assuntos
Biomarcadores/sangue , Dor Crônica/diagnóstico , Molécula 1 de Adesão Intercelular/sangue , Adulto , Idoso , Idoso de 80 Anos ou mais , Área Sob a Curva , Teorema de Bayes , Estudos de Casos e Controles , Dor Crônica/patologia , Citocinas/sangue , Ensaio de Imunoadsorção Enzimática , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Curva ROC , Adulto Jovem
14.
Spine (Phila Pa 1976) ; 42(4): E226-E233, 2017 Feb 15.
Artigo em Inglês | MEDLINE | ID: mdl-28207662

RESUMO

STUDY DESIGN: A prospective evaluation of microRNA (miRNA) expression in patients with chronic low back pain (CLBP). OBJECTIVE: The aim of this study was to evaluate whether pain- and T cell-related miRNAs are differentially expressed in CLBP when compared with healthy volunteers and whether these miRNAs may distinguish between responders and nonresponders to a multidisciplinary treatment program. SUMMARY OF BACKGROUND DATA: CLBP is a common health problem worldwide. Multidisciplinary pain treatment programs have been proven as an effective treatment option. miRNAs are known to be important mediators of gene regulation in various processes, including pathophysiology of pain. The expression of miRNAs in CLBP and changes due to a multidisciplinary treatment programs are still unknown. METHODS: Thirty-four patients with CLBP were enrolled (46.5 ±â€Š12.7 yrs). CLBP was defined as low back pain with an average intensity of numerical rating scale (NRS) ≥3 during the last 4 weeks, persisting longer than 6 months, and not attributable to a recognized specific pathological condition. Expression of pain- and T cell-related miRNAs in human CD4 cells were determined using TaqMan assays and RealTime PCR. MiRNA expression in patients with CLBP was compared with the expression in healthy volunteers before a multidisciplinary treatment program started. The multidisciplinary outpatient program (4 weeks, 5 days a week, 8 h per day) is a clinically established outpatient program and comprises medical (examination, education), physical (exercise), work-related, and psychological therapy components. After the program, differentially expressed miRNAs in CLBP (before treatment) were analyzed once more. Expression of these miRNAs in patients who respond to the treatment (n = 14) was compared with those who did not respond (n = 20). Response to therapy was defined as reduction of pain of ≥50% (NRS) from baseline. RESULTS: MiRNA-124a (patients: 0.79 ±â€Š0.63 vs. healthy volunteers: 0.30 ±â€Š0.16; P < 0.001), miRNA-150 (patients: 0.75 ±â€Š0.21 vs. healthy volunteers: 0.56 ±â€Š0.20; P = 0.025), and miRNA-155 (patients: 0.55 ±â€Š0.14 vs. healthy volunteers: 0.38 ±â€Š0.16; P = 0.017) were significantly upregulated in CLBP patients when compared with healthy volunteers. After the multidisciplinary treatment program, patients who respond to the treatment showed only an increase of miRNA-124a expression (before treatment: 0.54 ±â€Š0.26 vs. after treatment: 1.05 ±â€Š0.56, P = 0.007). CONCLUSION: MiRNA-124a upregulation is associated with therapy response in a multidisciplinary treatment programs and might help to identify more specific and mechanism-based treatment strategies for CLBP. LEVEL OF EVIDENCE: 3.


Assuntos
Dor Lombar/metabolismo , Dor Lombar/terapia , MicroRNAs/genética , Adulto , Idoso , Doença Crônica , Terapia Combinada/métodos , Terapia por Exercício/métodos , Feminino , Humanos , Dor Lombar/diagnóstico , Masculino , Pessoa de Meia-Idade , Medição da Dor/métodos , Estudos Prospectivos , Resultado do Tratamento
15.
J Neuroinflammation ; 13(1): 248, 2016 09 20.
Artigo em Inglês | MEDLINE | ID: mdl-27646435

RESUMO

BACKGROUND: Accumulating evidence indicates that neuropathic pain is a neuro-immune disorder with enhanced activation of the immune system. Recent data provided proof that neuropathic pain patients exhibit increased numbers of immunosuppressive regulatory T cells (Tregs), which may represent an endogenous attempt to limit inflammation and to reduce pain levels. We here investigate the molecular mechanisms underlying these alterations. METHODS: Our experimental approach includes functional analyses of primary human T cells, 3'-UTR reporter assays, and expression analyses of neuropathic pain patients' samples. RESULTS: We demonstrate that microRNAs (miRNAs) are involved in the differentiation of Tregs in neuropathic pain. We identify miR-124a and miR-155 as direct repressors of the histone deacetylase sirtuin1 (SIRT1) in primary human CD4(+) cells. Targeting of SIRT1 by either specific siRNA or by these two miRNAs results in an increase of Foxp3 expression and, consecutively, of anti-inflammatory Tregs (siRNA: 1.7 ± 0.4; miR-124a: 1.5 ± 0.4; miR-155: 1.6 ± 0.4; p < 0.01). As compared to healthy volunteers, neuropathic pain patients exhibited an increased expression of miR-124a (2.5 ± 0.7, p < 0.05) and miR-155 (1.3 ± 0.3; p < 0.05) as well as a reduced expression of SIRT1 (0.5 ± 0.2; p < 0.01). Moreover, the expression of these two miRNAs was inversely correlated with SIRT1 transcript levels. CONCLUSIONS: Our findings suggest that in neuropathic pain, enhanced targeting of SIRT1 by miR-124a and miR-155 induces a bias of CD4(+) T cell differentiation towards Tregs, thereby limiting pain-evoking inflammation. Deciphering miRNA-target interactions that influence inflammatory pathways in neuropathic pain may contribute to the discovery of new roads towards pain amelioration. TRIAL REGISTRATION: German Clinical Trial Register DRKS00005954.


Assuntos
Diferenciação Celular/fisiologia , Regulação da Expressão Gênica/genética , MicroRNAs/metabolismo , Neuralgia/patologia , Linfócitos T Reguladores/fisiologia , Adulto , Idoso , Antígenos CD/metabolismo , Diferenciação Celular/efeitos dos fármacos , Células Cultivadas , Feminino , Fatores de Transcrição Forkhead/genética , Fatores de Transcrição Forkhead/metabolismo , Humanos , Masculino , MicroRNAs/genética , Pessoa de Meia-Idade , Mutagênese/genética , Neuralgia/imunologia , Neuralgia/metabolismo , RNA Mensageiro/metabolismo , RNA Interferente Pequeno/farmacologia , Sirtuína 1/genética , Sirtuína 1/metabolismo , Linfócitos T Reguladores/efeitos dos fármacos , Linfócitos T Reguladores/patologia , Transfecção
16.
J Neuroinflammation ; 13(1): 100, 2016 May 04.
Artigo em Inglês | MEDLINE | ID: mdl-27145808

RESUMO

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-1ß 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-1ß 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-1ß serum concentrations were significantly elevated only in NeP patients (1.4-fold, p = 0.04). CONCLUSIONS: A significant upregulation of P2X7R and increased IL-1ß 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.


Assuntos
Interleucina-1beta/sangue , Neuralgia/sangue , Neuralgia/imunologia , Receptores Purinérgicos P2X7/sangue , Adulto , Separação Celular , Dor Crônica/sangue , Feminino , Citometria de Fluxo , Humanos , Interleucina-1beta/análise , Interleucina-1beta/biossíntese , Dor Lombar/sangue , Linfócitos/imunologia , Masculino , Pessoa de Meia-Idade , Monócitos/imunologia , Reação em Cadeia da Polimerase em Tempo Real , Receptores Purinérgicos P2X7/análise , Receptores Purinérgicos P2X7/biossíntese
17.
Ann Vasc Surg ; 34: 193-9, 2016 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-27177708

RESUMO

BACKGROUND: Atherosclerosis of the carotid artery is a major source of stroke. In some cases, atherosclerosis occurs at several positions within the carotid artery. Carotid endarterectomy (CEA) in combination with retrograde balloon angioplasty and stenting of a brachiocephalic or common carotid artery stenosis has been described as efficacious and safe procedure to prevent stroke in these cases. The aim of this study was to analyze the impact of anesthetic techniques on hemodynamic factors, operation time, duration of clamping, and postoperative pain. METHODS: A retrospective analysis of patients undergoing CEA in combination with retrograde stenting under either general anesthesia (GA) or cervical block (CB) was carried out. Preoperative risk factors were analyzed as well as operating and cross-clamping time, hemodynamic factors, perioperative complications, postoperative pain, application of pain killers, and duration of intensive care unit (ICU) and hospital stay. RESULTS: Operating (GA: 193 ± 91 min vs. CB: 125 ± 52 min, P = 0.029) and cross-clamping time (GA: 34 ± 12 min vs. CB: 26 ± 9 min, P < 0.001) were shorter under CB. Patients under CB were hemodynamically more stable and required less norepinephrine (GA: 1.1 ± 0.6 mg vs. CB: 0.1 ± 0.1 mg, P < 0.001) and crystalloids (GA: 2,813 ± 1,173 mL vs. CB: 1,088 ± 472 mL, P < 0.001). Postoperative pain levels (GA: numeric rating scale 4.3/10 vs. 2.0/10; P = 0.004) and requirement of pain killers were also lower within the CB group. CONCLUSIONS: Synchronous CEA and retrograde balloon angioplasty and stenting of a brachiocephalic or common carotid artery stenosis under CB is associated with reduction of operating and cross-clamping time, improved hemodynamical stability, lower postoperative pain, shorter ICU and hospital stay, and it offers the advantage of a continuous neurological monitoring.


Assuntos
Anestesia Geral , Angioplastia com Balão/instrumentação , Arteriopatias Oclusivas/terapia , Artéria Carótida Primitiva/cirurgia , Estenose das Carótidas/cirurgia , Endarterectomia das Carótidas , Bloqueio Nervoso , Stents , Idoso , Analgésicos/uso terapêutico , Anestesia Geral/efeitos adversos , Angioplastia com Balão/efeitos adversos , Arteriopatias Oclusivas/complicações , Arteriopatias Oclusivas/diagnóstico por imagem , Arteriopatias Oclusivas/fisiopatologia , Tronco Braquiocefálico/diagnóstico por imagem , Tronco Braquiocefálico/fisiopatologia , Artéria Carótida Primitiva/diagnóstico por imagem , Artéria Carótida Primitiva/fisiopatologia , Estenose das Carótidas/complicações , Estenose das Carótidas/diagnóstico por imagem , Estenose das Carótidas/fisiopatologia , Constrição , Endarterectomia das Carótidas/efeitos adversos , Hemodinâmica , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Bloqueio Nervoso/efeitos adversos , Duração da Cirurgia , Medição da Dor , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/etiologia , Dor Pós-Operatória/prevenção & controle , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
18.
J Neuroinflammation ; 12: 12, 2015 Jan 21.
Artigo em Inglês | MEDLINE | ID: mdl-25608762

RESUMO

BACKGROUND: The classification of pain into nociceptive and neuropathic pain is based on characteristic symptoms and different pathophysiological mechanisms. In a recent investigation, we found a disrupted TH17/Treg balance in patients suffering from chronic unspecific low back pain (CLBP). These patients did not show any signs of neuropathy. There is evidence for a considerable impact of the immune system also in neuropathic pain. However, the role of the adaptive immune system is still unclear. In the present study, we investigated systemic T-cell subset responses and T-cell related cytokine profiles in patients with chronic neuropathic pain. METHODS: We analyzed T-cell subsets, mRNA expression and T-cell-related cytokine profiles in 26 patients suffering from neuropathic pain in comparison to 26 healthy controls. Using multicolor flow cytometry (FACS), we quantified the number of T helper cells 1 (TH1), TH2, TH17 and regulatory T-cells (Tregs). Forkhead-Box-Protein 3 (FoxP3), Transforming growth factor-ß (TGF-ß) and RAR-related orphan receptor-γT (ROR-γT) mRNA expression was determined by quantitative real-time PCR (qPCR) and levels of pain-related cytokines were measured by Human Cytokine Multiplex Immunoassay (Macrophage inflammatory protein-1α (MIP-1α), Tumor necrosis factor-α (TNF-α), Interferon-γ (IFN-γ), Interleukin (IL) -4, IL-6, IL-10, IL-17, and IL-23). RESULTS: We found a TH17/Treg imbalance with significantly increased anti-inflammatory Tregs and decreased pro-inflammatory TH17 cells in patients with neuropathic pain as compared to healthy controls. These results were confirmed on mRNA level: Treg-related FoxP3 and TGF-ß mRNA expression was elevated, whereas expression of TH17-related RORγT was reduced. Cytokine analyses revealed only marginal changes. CONCLUSIONS: Our investigation revealed a clear shift of T-cell subsets towards anti-inflammation in patients with neuropathic pain. Interestingly, this is quite similar to our previous findings in CLBP patients, but even more pronounced. Therefore, it remains to be elucidated in future investigations whether the immune changes represent an underlying pathophysiological mechanism or an epiphenomenon induced by ongoing pain and stress. GERMAN CLINICAL TRIAL REGISTER (DRKS): Trial registration number: DRKS00005954.


Assuntos
Citocinas/metabolismo , Neuralgia/metabolismo , Neuralgia/patologia , Subpopulações de Linfócitos T/metabolismo , Adulto , Idoso , Animais , Citocinas/genética , Ensaio de Imunoadsorção Enzimática , Feminino , Citometria de Fluxo , Granulócitos/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , RNA Mensageiro , Ratos , Estatísticas não Paramétricas
19.
Eur J Immunol ; 45(1): 260-72, 2015 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-25308712

RESUMO

T-cell functions must be tightly controlled to keep the balance between vital proinflammatory activity and detrimental overactivation. MicroRNA-146a (miR-146a) has been identified as a key negative regulator of T-cell responses in mice. Its role in human T cells and its relevance to human inflammatory disease, however, remains poorly defined. In this study, we have characterized miR-146a-driven pathways in primary human T cells. Our results identify miR-146a as a critical gatekeeper of Th1-cell differentiation processes acting via molecular mechanisms not uncovered so far. MiR-146a targets protein kinase C epsilon (PRKCε), which is part of a functional complex consisting of PRKCε and signal transducer and activator of transcription 4 (STAT4). Within this complex, PRKCε phosphorylates STAT4, which in turn is capable of promoting Th1-cell differentiation processes in human CD4(+) T lymphocytes. In addition, we observed that T cells of sepsis patients had reduced levels of miR-146a and an increased PRKCε expression in the initial hyperinflammatory phase of the disease. Collectively, our results identify miR-146a as a potent inhibitor of Th1-cell differentiation in human T cells and suggest that dysregulation of miR-146a contributes to the pathogenesis of sepsis.


Assuntos
MicroRNAs/genética , Proteína Quinase C-épsilon/genética , Fator de Transcrição STAT4/genética , Sepse/genética , Células Th1/imunologia , Diferenciação Celular , Regulação da Expressão Gênica , Humanos , MicroRNAs/imunologia , Fosforilação , Cultura Primária de Células , Proteína Quinase C-épsilon/imunologia , Fator de Transcrição STAT4/imunologia , Sepse/imunologia , Sepse/patologia , Transdução de Sinais , Células Th1/patologia
20.
J Surg Case Rep ; 2014(12)2014 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-25452261

RESUMO

Aneurysms of the internal mammary artery are extremely rare, and their presentation and treatment are variable. Since these aneurysms often tend to rupture and cause haemothorax and life-threatening conditions, the knowledge of secure treatment options is indispensable. We here report the case of an idiopathic internal mammary aneurysm in a 46-year-old man. Open surgical resection of the aneurysm was performed in this case without any complications. The postoperative course was uneventful and the patient was in a good physical condition without any vascular or neurological abnormalities during follow-up.

SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...