The Effect of Anakinra on Acrylamide-induced Peripheral Neuropathy and Neuropathic Pain in Rats

Abstract Acrylamide is a neurotoxic compound. Moreover, anakinra is an interleukin-1 (IL-1) receptor antagonist used in rheumatoid arthritis treatment. This study investigated the effect of anakinra on acrylamide-related neuropathy and neuropathic pain. Acrylamide exposure caused a significant decrease in the pain threshold; an increase in malondialdehyde (MDA), tumor necrosis factor-alpha (TNF-α), and interleukin-1 beta (IL-1ß) levels; and a decrease in total glutathione (tGSH) values in the sciatic nerve. This indicates hyperalgesia presence, oxidative stress, and peripheral nerve tissue inflammation. Anakinra treatment significantly reduced the MDA, IL-1ß, and TNF-α levels, and increased the pain threshold and mean tGSH values. The analgesic effect of anakinra was 67.9% at the first hour, increasing to 74.9% and 76.7% at the second and third hours, respectively. The group receiving acrylamide exhibited histopathological changes (e.g., swollen and degenerated axons, hypertrophic and hyperplasic Schwann cells, and congested vessels). The use of anakinra significantly improved these morphological changes. Anakinra is concluded to reduce neuropathic pain and prevent neurotoxic effect of acrylamide on peripheral nerves due to its analgesic, antioxidant, and anti-inflammatory properties

Do Australian Football players have sensitive groins? Players with current groin pain exhibit mechanical hyperalgesia of the adductor tendon.

OBJECTIVES: This is the first study to evaluate the mechanical sensitivity, clinical classifications and prevalence of groin pain in Australian football players. DESIGN: Case-control. METHODS: Professional (n=66) and semi-professional (n=9) Australian football players with and without current or previous groin injuries were recruited. Diagnoses were mapped to the Doha Agreement taxonomy. Point and career prevalence of groin pain was calculated. Pressure pain thresholds (PPTs) were assessed at regional and distant sites using handheld pressure algometry across four sites bilaterally (adductor longus tendon, pubic bone, rectus femoris, tibialis anterior muscle). To assess the relationship between current groin pain and fixed effects of hyperalgesia of each site and a history of groin pain, a mixed-effect logistic regression model was utilised. Receiver Operator Characteristic (ROC) curve were determined for the model. RESULTS: Point prevalence of groin pain in the preseason was 21.9% with a career prevalence of 44.8%. Adductor-related groin pain was the most prevalent classification in the pre-season period. Hyperalgesia was observed in the adductor longus tendon site in athletes with current groin pain (OR=16.27, 95% CI 1.86 to 142.02). The ROC area under the curve of the regression model was fair (AUC=0.76, 95% CI 0.54 to 0.83). CONCLUSIONS: Prevalence data indicates that groin pain is a larger issue than published incidence rates imply. Adductor-related groin pain is the most common diagnosis in pre-season in this population. This study has shown that hyperalgesia exists in Australian football players experiencing groin pain indicating the value of assessing mechanical pain sensitivity as a component of the clinical assessment.

EEG-Based Tonic Cold Pain Characterization Using Wavelet Higher Order Spectral Features.

A novel approach in tonic cold pain characterization, based on electroencephalograph (EEG) data analysis using wavelet higher order spectral (WHOS) features, is presented here. The proposed WHOS-based feature space extends the relative power spectrum-based (phase blind) approaches reported so far a step forward; this is realized via dynamic monitoring of the nonlinerities of the EEG brain response to tonic cold pain stimuli by capturing the change in the underlying quadratic phase coupling at the bifrequency wavelet bispectrum/bicoherence domain due to the change of the pain level. Three pain characterization scenarios were formed and experimentally tested involving WHOS-based analysis of EEG data, acquired from 17 healthy volunteers that were subjected to trials of tonic cold pain stimuli. The experimental and classification analysis results, based on four well-known classifiers, have shown that the WHOS-based features successfully discriminate relax from pain status, provide efficient identification of the transition from relax to mild and/or severe pain status, and translate the subjective perception of pain to an objective measure of pain endurance. These findings seem quite promising and pave the way for adopting WHOS-based approaches to pain characterization under other types of pain, e.g., chronic pain and various clinical scenarios.

¿Cómo encajará la terapia focal en los tratamientos existentes? / How will focal therapy fit in with existing treatments?

Contexto: El manejo actual del cáncer de próstata localizado supone un reto terapéutico con diferentes opciones, incluyendo las activas radicales o el seguimiento activo. El objetivo de este trabajo es analizar la posibilidad y validez del tratamiento activo «focal» frente al concepto de seguimiento activo o tratamiento radical. Adquisición de evidencia: Realizamos una revisión de la literatura sobre los diferentes métodos diagnósticos, ventajas o dificultades del seguimiento activo y tratamiento radical frente a la terapia focal, con las posibilidades de definición de características de agresividad y selección de pacientes. Síntesis de evidencia: Las técnicas de biopsia con rejilla junto con la resonancia nuclear magnética nuclear multiparamétrica y la asociación de factores como el tamaño del tumor, la longitud del cilindro afecto y Gleason son parámetros que nos permiten afinar en la localización y definición de tumores clínicamente significantes y subsidiarios de terapias focales. Conclusiones: La definición, localización y agresividad del cáncer de próstata en tumores de riesgo bajo-intermedio puede ser definida evitando las terapias radicales con sus efectos secundarios, o los riesgos de subestimar tumores como en el seguimiento activo con los mínimos efectos secundarios (AU)

Context: The current management of localized prostate cancer is a therapeutic challenge with different options including active radicals or active follow-up. The aim of this paper is to analyze the feasibility and validity of the “Focal” active treatment versus the concept of active follow-up or Radical Treatment. Evidence acquisition: We reviewed the literature on the various diagnostic methods, advantages, and difficulties of active follow-up and Radical Treatment, versus focal therapy with the possibilities of defining characteristics of aggressiveness and patient selection. Evidence synthesis: The mesh biopsy techniques along with multiparametric magnetic resonance imaging and association of factors such as tumor size, length of affected cylinder and Gleason are parameters that allow us to define location and definition of clinically significant tumors and subsidiary of focal therapies. Conclusions: The definition, location and aggressiveness of prostate cancer in low-intermediate risk tumors can be defined avoiding radical therapies with their side effects or the risks of underestimating tumors as in active follow-up without the minimum side effects (AU)

Genetic contributions to pain: a review of findings in humans.

Pain represents the major motivating factor for which individuals seek healthcare, and pain responses are characterized by substantial inter-individual differences. Increasing evidence suggests that genetic factors contribute significantly to individual differences in responses to both clinical and experimental pain. The purpose of this review article was to summarize the current literature regarding genetic contributions to pain, highlighting findings relevant to oral pain where available. A brief discussion of methodologic considerations is followed by a review of findings regarding genetic influences on clinical pain. Next, the literature examining genetic contributions to experimental pain responses is presented, emphasizing genetic associations that have been replicated in multiple cohorts. It is hoped that an enhanced understanding of genetic contributions to pain responses will ultimately improve diagnosis and treatment of clinical pain conditions.

El dolor en los pacientes con artritis reumatoide: variables psicológicas relacionadas e intervención / Pain in patients with rheumatoid arthritis: psychological variables and interventions

El dolor es un síntoma principal en los pacientes con Artritis Reumatoide (AR), generalmente determinando su ajuste a la enfermedad y su calidad de vida global. Este artículo presenta una revisión y discusión sobre el dolor en pacientes con AR desde un enfoque psicológico basado en las investigaciones recientes. Se repasan los trabajos que han evaluado las emociones negativas en los pacientes con AR, aquellos que han explorado y explicado su papel sobre el dolor del enfermo, así como un compendio de las técnicas psicológicas más efectivas para el manejo del dolor. Las conclusiones muestran que el dolor es un problema central en los pacientes con AR. Las emociones negativas, que parecen estar presentes de forma más marcada en los pacientes con AR que en la población sana, son predictores significativos del dolor. Por otra parte, los estudios sugieren que el enfoque cognitivo-conductual es eficaz para los pacientes con AR en la mejora no sólo del dolor sino también en el ajuste psicológico a la enfermedad, mostrando un beneficio adicional para los pacientes con AR que reciben tales intervenciones como complemento del cuidado médico habitual. Para el futuro, el artículo sugiere la necesidad de realizar más estudios sobre los patrones de emocionalidad negativa y estrategias de afrontamiento es muestras españolas (AU)

Pain is a key symptom in patients with rheumatoid arthritis (RA), usually determining the patient’s adjustment to illness and his/her overall quality of life. Based on recent research, this article provides a review and discussion of RA pain from a psychological approach. Negative emotions and their relations to pain are assessed, and the most effective psychological techniques for pain management are described. It is concluded that pain is a key symptom in RA patients, being frequently predicted by negative emotions –which are more prevalent in RA patients than in the general population. Moreover, studies suggest that the cognitive-behavioural approach is effective in RA patients since it improves not only the pain but also the psychological fit to the disease, being an additional benefit for RA patients when this approach adds to the standard medical care. With a view to the future, this paper suggests the need of further studies with Spanish samples on negative emotions and coping skills patterns related to pain (AU)

Multidimensional tools: application of pain quality cards in children / Instrumentos multidimensionales: aplicación de las tarjetas de las cualidades del dolor en niños / Instrumentos multidimensionais: aplicação dos cartões das qualidades da dor em crianças

This pilot, descriptive and field exploratory study aimed to verify the representative of the quality of pain, applying the Pain Quality Cards to 50 children and teenagers hospitalized in the first half of 2004, after being approved by the Ethic Commission. Results have shown that there is no relationship between the age group and the number of positive answers. The identification of the cards was different to each group, 61,1 percent of the cards were identified for the pre-scholar, 77,8 percent for the scholar and 27,8 for the teenagers. The use of the instrument has revealed itself successful and able to evaluate, discriminate and measure the different dimensions of pain.

Estudio piloto, descriptivo y exploratorio de campo. El objetivo fue verificar la representatividad de las cualidades del dolor de niños y adolescentes, aplicando las Tarjetas de las Cualidades del Dolor a 50 niños y adolescentes en el primero semestre de 2004, después de obtener la autorización del comité de ética de la escuela de la enfermería. Los resultados apuntaron no haber correlación entre grupo de determinada edad y número de respuestas afirmativas. La identificación de las tarjetas fue distinta para cada grupo, es decir, 61,1 por ciento de las tarjetas fueron identificadas para el pre-escolar, 77,8 por ciento para el escolar y 27,8 por ciento para el adolescente. La utilización del instrumento mostró ser factible y capaz de evaluar, discriminar y mensurar las distintas dimensiones del dolor.

Estudo piloto, descritivo e exploratório de campo. O objetivo foi verificar a representatividade das qualidades da dor de crianças e adolescentes, aplicando os Cartões das Qualidades da Dor a 50 crianças e adolescentes no primeiro semestre de 2004, após obter a aprovação do Comitê de Ética da Escola de Enfermagem, USP. Os resultados apontaram não haver correlação entre faixa etária e número de respostas afirmativas. A identificação dos cartões foi diferente para cada grupo, ou seja, 61,1 por cento dos cartões foram identificados para o pré-escolar, 77,8 por cento para o escolar e 27,8 por cento para o adolescente. A utilização do instrumento mostrou ser factível e capaz de avaliar, discriminar e mensurar as diferentes dimensões da dor.

Dolor en neonatos / Pain in neonates

Tradicionalmente, el dolor en el niño se ha tratado deforma insuficiente. Se pensaba que la incapacidad de losniños para verbalizar sus sentimientos y expresar su dolorera sinónimo de incapacidad para experimentarlo y recordarlo.Los neonatos a menudo deben someterse a intervencionesinvasivas, y en la actualidad existen datos suficientespara afirmar que el neonato es capaz de percibir el dolor.El tratamiento insuficiente del dolor conlleva un aumentode la morbimortalidad. En los últimos años se han producidonumerosos avances en el cuidado y manejo del reciénnacido. Existen diversas escalas de medida del dolor para lavaloración de este en neonatos a término y pretérmino.Estas se basan en la observación y recogida de las alteracionesfisiológicas, cambios del comportamiento, o unacombinación de ambos. En este artículo se hace un repasopor las más utilizadas. Hay una serie de medidas generalesde vital importancia en el tratamiento del dolor en neonatos,como es evitar procedimientos dolorosos innecesarios,el cuidado del ambiente que le rodea, distintos tipos de solucionesorales dulces, la estimulación multisensorial, asícomo amamantar el pecho de su madre durante la intervencióndolorosa. Sin embargo, hay ocasiones en las queestos recursos son insuficientes y hemos de recurrir a lasmedidas farmacológicas. Los fármacos más utilizados sonlos anestésicos locales, opioides y analgésicos antiinflamatoriosno esteroideos. Hay situaciones estresantes y no dolorosaspara el neonato, en las que el tratamiento adecuadoes la sedación. Incluimos el hidrato de cloral,remifentanilo o midazolam

Pain in children has been traditionally inadequatelymanaged. It was though that children inability to verbalizefeelings and express pain was synonymous of their inabilityto feel and remember pain. Neonates frequently have toundergo invasive procedures and currently there are notenough data to state that the neonate is unable to perceivepain. Inadequate management of pain causes an increaseof morbi-mortality. In the past years there has been manyadvances in the care and management of the neonate.There are several scales for measuring and assessing painin the neonate at term and pre-term. These are based onthe observation and recording of physiological disorders,behavioral changes or a combination of both. In this paper,we review the scales more frequently used. Several generalmeasures are critically relevant for the management ofpain in the neonate, such as avoidance of unnecessarypainful procedures, control of environmental conditions,different types of sweet oral solutions, multisensitive stimulationand breastfeeding of the mother during the painfulprocedure. However, sometimes all these resources are notenough and we have to use pharmacological measures.The most commonly used drugs are local anesthetics, opiatesand non-steroid anti-inflammatory analgesics. Somesituations can be stressful and non-painful for the neonate and in this cases sedations is the appropriate treatment.We consider chloral hydrate, remifentanyl and midazolam

[Nociceptive sensitivity and environmental factors]. / Notsitseptivnaia chuvstvitel'nost' i faktory okruzhaiushchei sredy.

The authors dwell upon the structure and functioning of the nociceptive system and modification of pain sensitivity by ambient factors like air temperature and atmospheric pressure.

Avaliação quantitativa da sensibilidade cutânea do abdome após abdominoplastia / Quantitative assessment of the abdomen skin sensibility after abdominoplasty

Alterações da sensibilidade cutânea são comuns após diversos procedimentos em Cirurgia Plástica. Embora estudos anteriores analisem resultados estéti- cos, associações de procedimentos e novas técnicas em abdominoplastias, poucos são aqueles que avaliam o efeito do descolamento na sensibilidade cutânea. O presente estudo tem a finalidade de analisar e quantificar a sensibilidade cutânea após abdomi- noplastia clássica. Foram utilizados dois grupos de pacientes. Um grupo controle de dez pacientes não operadas, sem patologias prévias e outro grupo de vinte e cinco pacientes submetidas a abdominoplastia clássica. A superfície abdominal foi dividida em nove regiões. A avaliação da sensibilidade dolorosa foi realizada através de testes com agulhas. A sensibilidade térmica através de tubos de ensaio contendo água resfriada e aquecida. O tato superficial foi testado utilizando-se o Pressure-Specified Sensory Device(PSSD) que é um dispositivo capaz de determinar o limiar cutâneo de pressão. A análise estatística foi realizada através do teste “t de Student”, o nível de significância adotado foi p<0.05. Os resultados demonstraram diminuição da sensibilidade nas três modalidades. A análise estatística revelou diferença significante (p>0,05) entre os grupos em todas as regiões testadas. As regiões mais centrais do abdome, mesogastro e hipogastro, foram aquelas que apresentaram maior anestesia térmica e dolorosa e maiores limiares cutâneos de pressão.

Changes in cutaneous sensibility are common after diverse surgical procedures in Plastic Surgery.Although previous studies analyze aesthetic results in abdominoplastys, few are those that evaluate the effect of the flap elevation in cutaneous sensibility. The present study it has the purpose to analyze and to quantify cutaneous sensibility after classic abdominoplasty. Two groups of patients had been studied, one group of ten patients was not operated. Another group of twenty and five patients were submitted to classic abdominoplasty. The abdominal surface was divided in nine regions. The evaluation of painful sensitivity was carried through tests with needles. Thermal sensitivity through small tubes filled with cooled and warm water. The superficial touch was tested using the Pressure-Specified Sensory Device (PSSD) that it is a device able to de- termine the cutaneous threshold of pressure. Statistics analysis was carried out through Student t test with a significance level of p<0.05. The results had demonstrated reduction of sensitivity in the three modalities. Statistics analysis disclosed significant differences (p>0,05) between the groups in all tested regions. Central areas in abdominal wall had been those that had presented greater thermal and painful anesthesia and greater cutaneous pressure thresholds.