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2.
Anticancer Res ; 40(10): 5701-5706, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32988895

RESUMO

BACKGROUND/AIM: The simultaneous increase of antioxidant CAT (catalase) enzyme and plasma MDA (malonidialdehyde) concentrations versus the numeric rating scale (NRS) pain score following surgery is unknown. Patients and Methods: The study included 114 patients with gallstone disease and 29 patients in the cancer group. RESULTS: Following surgery, the plasma CAT concentrations increased and plasma MDA concentrations decreased in all patients and especially in cancer patients. The linear mixed model time-effect was statistically significant in CAT and MDA (p<0.001 and p=0.02, respectively). In addition, a significant correlation between NRS pain score values and plasma MDA median concentrations in cancer patients was identified (r=0.430, p<0.001). CONCLUSION: The plasma MDA concentrations decreased and CAT concentrations increased significantly in all patients and especially in cancer patients following surgery. The simultaneous increase of antioxidant CAT enzyme with the decrease of plasma MDA may be an important ROS inhibiting mechanism to help patients return to normal antioxidant-oxidant status.


Assuntos
Catalase/sangue , Cálculos Biliares/sangue , Malondialdeído/sangue , Neoplasias/sangue , Dor/sangue , Antioxidantes/metabolismo , Feminino , Cálculos Biliares/patologia , Cálculos Biliares/cirurgia , Glutationa Peroxidase/sangue , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/patologia , Neoplasias/cirurgia , Estresse Oxidativo/genética , Dor/patologia , Dor/cirurgia , Medição da Dor , Espécies Reativas de Oxigênio/metabolismo , Superóxido Dismutase/sangue
3.
PLoS One ; 15(9): e0238123, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32881944

RESUMO

An effective and pain-free killing method is required to achieve the goal of euthanasia, a "good death". Overdose of sodium pentobarbital (PB) by intraperitoneal (IP) injection is a widely accepted technique in laboratory rats, but questions remain regarding pain associated with administration. As PB rapidly causes sedation and loss of consciousness, most studies have relied on indirect evidence of pain. The objective of this study was to assess pain associated with IP PB using an appropriate vehicle control. Adult male and female Sprague Dawley (SD) and female Wistar rats (N = 84) were block randomised by sex and strain to receive one of three treatments: 1) 800 mg/kg PB (pH 11), 2) saline or 3) vehicle controls (pH 11 or 12.5). Behavior (Rat Grimace Scale (RGS), writhing, back arching) was evaluated at baseline, before loss of righting reflex (LORR, PB group), and at 80s, 151s and 10 min post-injection (PI; saline and vehicle control groups). In the PB group, mean time to LORR was 78 ± 7.9 seconds. In the vehicle control groups, RGS scores were increased at 151s PI (SD: p = 0.0002, 95%CI 0.73 to 0.20) from baseline, as was relative frequency of writhing (SD: p < 0.0001; Wistar; p = 0.0004). RGS scores remained elevated 10 mins PI (SD: p = 0.0005, 95%CI 0.71 to 0.18; Wistar: p = 0.0234, 95%CI 0.91 to 0.07) but the relative frequency of writhing did not (p > 0.999). The RGS scores and the relative frequency of writhing remained low in the PB and saline groups (p > 0.05). These results show that, vehicle controls for IP PB result in signs associated with pain, pain may not be experienced following IP PB when LORR occurs quickly, and that the effects of PB limit behavioral pain assessments.


Assuntos
Hipnóticos e Sedativos/administração & dosagem , Dor/tratamento farmacológico , Pentobarbital/administração & dosagem , Animais , Comportamento Animal , Feminino , Injeções Intraperitoneais , Fígado/patologia , Masculino , Músculos/patologia , Dor/patologia , Ratos , Ratos Sprague-Dawley , Ratos Wistar
4.
PLoS One ; 15(9): e0239231, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32997686

RESUMO

It is controversially discussed whether immune-deficient mice experience severity in the absence of infection. Because a comprehensive analysis of the well-being of immune-deficient mice under specific pathogen free conditions is missing, we used a multi-parametric test analyzing, corticosterone, weight, nest building and facial expression over a period of 9 month to determine the well-being of two immune-deficient mouse lines (recombination activating gene 2- and interferon gamma receptor-deficient mice). We do not find evidence for severity when comparing immune-deficient mice to their heterozygous immune-competent littermates. Our data challenge the assumption that immune-deficiency per se regardless of housing conditions causes severity. Based on our study we propose to use objective non-invasive parameters determined by laboratory animal science for decisions concerning severity of immune-deficient mice.


Assuntos
Corticosterona/genética , Proteínas de Ligação a DNA/genética , Interferon gama/genética , Camundongos SCID/genética , Animais , Linfócitos B/imunologia , Corticosterona/imunologia , Humanos , Infecções/genética , Infecções/imunologia , Rim/metabolismo , Rim/patologia , Camundongos , Camundongos SCID/imunologia , Dor/genética , Dor/patologia , Receptores de Interferon/deficiência , Receptores de Interferon/genética , Transdução de Sinais/genética , Linfócitos T/imunologia , Testosterona/genética
5.
J Neurovirol ; 26(5): 800-801, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32779108

RESUMO

A woman in her forties with asthma and COPD was admitted to a general medical floor with respiratory symptoms, body aches, and anosmia. Reverse transcription polymerase chain reaction detected severe acute respiratory syndrome coronavirus-2. Admission labs, including biomarkers of the systemic immunological dysfunction seen in many cases of coronavirus disease 2019 (COVID-19), were within normal ranges. On the second day of admission, she developed neck and back pain that was constant, burning in quality, and exacerbated by light touch and heat. Wearing clothing caused pain and interfered with her sleep. The area was tender to light finger stroke. The patient was given acetaminophen, NSAIDs, and opioids with no relief of pain. However, gabapentin was effective. At follow-up 1 month later, her symptoms were improved and still relieved by gabapentin. Neuropathic pain was seen in over 2% of COVID-19 patients in one observational study. The pain seen in our case was bilateral, involved an area innervated by multiple levels of spinal nerves, and was limited to the back. While it is rare, a significant number of COVID-19 patients are afflicted by neuropathic pain, and our case illustrates that gabapentin may be effective.


Assuntos
Síndrome de Sobreposição da Doença Pulmonar Obstrutiva Crônica e Asma/complicações , Dor nas Costas/complicações , Infecções por Coronavirus/complicações , Cervicalgia/complicações , Transtornos do Olfato/complicações , Dor/complicações , Pneumonia Viral/complicações , Acetaminofen/uso terapêutico , Analgésicos/uso terapêutico , Síndrome de Sobreposição da Doença Pulmonar Obstrutiva Crônica e Asma/tratamento farmacológico , Síndrome de Sobreposição da Doença Pulmonar Obstrutiva Crônica e Asma/patologia , Síndrome de Sobreposição da Doença Pulmonar Obstrutiva Crônica e Asma/virologia , Dor nas Costas/tratamento farmacológico , Dor nas Costas/patologia , Dor nas Costas/virologia , Betacoronavirus/patogenicidade , Infecções por Coronavirus/tratamento farmacológico , Infecções por Coronavirus/patologia , Infecções por Coronavirus/virologia , Feminino , Gabapentina/uso terapêutico , Humanos , Pessoa de Meia-Idade , Cervicalgia/tratamento farmacológico , Cervicalgia/patologia , Cervicalgia/virologia , Transtornos do Olfato/tratamento farmacológico , Transtornos do Olfato/patologia , Transtornos do Olfato/virologia , Dor/tratamento farmacológico , Dor/patologia , Dor/virologia , Pandemias , Pneumonia Viral/tratamento farmacológico , Pneumonia Viral/patologia , Pneumonia Viral/virologia , Resultado do Tratamento
6.
PLoS One ; 15(8): e0237359, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32790789

RESUMO

BACKGROUND: Patients diagnosed with obstructive sleep apnea (OSA), who also consume prescription opioids, have a greater likelihood of morbidity and mortality. This study evaluated whether a primary care team, focused on chronic pain care management, could use a validated questionnaire (STOP-Bang) and motivational follow-up, to increase identification and treatment of OSA. METHODS: This study was a retrospective, dual arm, pre/post controlled study. Participants of this study included the complete chronic pain management sub group treated by this primary care team. Participants were ≥ 18 years old and prescribed daily opioids for treatment of chronic pain. All participants had a multifaceted, individualized, educational meeting that included completing a STOP-Bang questionnaire. Participants who received a score ≥ three were advised to follow up with their primary care physician. Participants were seen quarterly throughout the study. RESULTS: The primary outcome of this study was that 65% of participants with likely OSA were using CPAP for a minimum of 12 months (range of 12-25 months, 18-month average) post-intervention vs. 37% CPAP-use in the control group (12 months of observation), both groups were chronic opioid users with OSA. This was a 28% relative improvement (p = 0.0034). A secondary outcome was that 8.9% of non-prior CPAP users obtained CPAP post- intervention; a 56.7% pre-post improvement (p = 0.0064, x2 = 10.08 with 1 degree of freedom). Also, participants who were likely to have OSA (STOP-Bang score ≥ 3 or had a positive polysomnography (AHI >5 with comorbidities)) compared to those unlikely to have OSA (STOP-Bang score <3 or had a negative polysomnography (AHI <5)) in this study were more likely to be male, have a higher BMI, have hypertension, have cardiovascular disease and/or have diabetes (all types). CONCLUSION: Team based care management for participants taking prescription opioids, where STOP-Bang questionnaires were completed, were associated with an increase in the identification and treatment of OSA.


Assuntos
Manejo da Dor/métodos , Dor/patologia , Apneia Obstrutiva do Sono/diagnóstico , Adulto , Idoso , Analgésicos Opioides/uso terapêutico , Índice de Massa Corporal , Doença Crônica , Feminino , Humanos , Hipertensão/patologia , Masculino , Pessoa de Meia-Idade , Dor/complicações , Dor/tratamento farmacológico , Polissonografia , Atenção Primária à Saúde , Estudos Retrospectivos , Fatores Sexuais , Apneia Obstrutiva do Sono/complicações , Apneia Obstrutiva do Sono/terapia , Inquéritos e Questionários
7.
PLoS One ; 15(7): e0236390, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32702007

RESUMO

BACKGROUND: Nurses have a primary role in providing palliative and end-of-life (EOL) care. Their knowledge of EOL care, attitudes toward care of the dying, and palliative care self-efficacy are important in care delivery. Little is known regarding palliative care preparedness among Mongolian nurses. This study examines palliative care knowledge, attitude towards death and dying, and self-efficacy among Mongolian nurses, and examines predictors of self-efficacy. METHODS: A cross-sectional descriptive study was conducted. Participants were 141 nurses employed at the National Cancer Center in Mongolia. Data was collected using a self-administered questionnaire. RESULTS: The median score for the knowledge of palliative care was 8.0/20. "Psychosocial and spiritual care" was the lowest score on the palliative care knowledge subscale. The mean score for attitude toward care of the dying was 69.1%, indicating positive attitudes. The mean score for the palliative care self-efficacy was 33.8/48. Nurses reported low self-efficacy toward communicating with dying patients and their families, and managing delirium. Palliative care knowledge and duration of experience as an oncology nurse significantly predicted self-efficacy toward palliative care, accounting for 14.0% of the variance. CONCLUSIONS: Palliative education for nurses should address the knowledge gaps in EOL care and focus in increasing palliative care self-efficacy. Considering palliative care knowledge and nursing experience as an oncology nurse were significant predictors of self-efficacy toward palliative care, more effort is needed to fill the knowledge gaps in EOL care among nurses, especially for less experienced nurses.


Assuntos
Atitude do Pessoal de Saúde , Conhecimentos, Atitudes e Prática em Saúde , Enfermeiras e Enfermeiros/normas , Cuidados Paliativos/normas , Adulto , Estudos Transversais , Feminino , Humanos , Masculino , Oncologia/tendências , Pessoa de Meia-Idade , Mongólia/epidemiologia , Dor/epidemiologia , Dor/patologia , Pacientes , Autoeficácia , Inquéritos e Questionários , Assistência Terminal
8.
J Vis Exp ; (159)2020 05 20.
Artigo em Inglês | MEDLINE | ID: mdl-32510505

RESUMO

The current animal models of osteoarthritis (OA) can be divided into spontaneous models and induced models, both of which aim to simulate the pathophysiological changes of human OA. However, as the main symptom in the late stage of OA, pain affects the patients' daily life, and there are not many available models. The mono-iodoacetate (MIA)-induced model is the most widely used OA pain model, mainly used in rodents. MIA is an inhibitor of glyceraldehyde-3-phosphate dehydrogenase, which causes chondrocyte death, cartilage degeneration, osteophyte, and measurable changes in animal behavior. Besides, expression changes of matrix metalloproteinase (MMP) and pro-inflammatory cytokines (IL1 ß and TNF α) can be detected in the MIA-induced model. Those changes are consistent with OA pathophysiological conditions in humans, indicating that MIA can induce a measurable and successful OA pain model. This study aims to describe the methodology of intra-articular injection of MIA in rats and discuss the resulting pain-related behaviors and histopathological changes.


Assuntos
Modelos Animais de Doenças , Ácido Iodoacético/administração & dosagem , Ácido Iodoacético/farmacologia , Osteoartrite/complicações , Dor/induzido quimicamente , Animais , Cartilagem Articular/efeitos dos fármacos , Cartilagem Articular/patologia , Condrócitos/efeitos dos fármacos , Condrócitos/metabolismo , Citocinas/metabolismo , Injeções Intra-Articulares , Masculino , Metaloproteinases da Matriz/metabolismo , Dor/complicações , Dor/patologia , Ratos
9.
PLoS One ; 15(6): e0234118, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32492064

RESUMO

OBJECTIVE: Breast cancer survivors (BCS) are often characterized by decreased pressure pain thresholds (PPT), range of motion (ROM) and strength in and around the shoulder affected by the treatment. This intra-rater reliability study was to establish the relative and absolute reliability of PPT's, active ROM and maximal isokinetic muscle strength (MIMS) of the affected shoulder in BCS with persistent pain after treatment. METHODS: Twenty-one BCS participated in the study. The PPTs of 17 locations and pain intensity were assessed using a pressure algometer and a numeric rating scale. The ROM was measured using a universal goniometer and MIMS was measured using an isokinetic dynamometer. Relative reliability was estimated using intra class correlation coefficient (ICC), and absolute reliability using standard error of measurement (SEM). Minimum detectable change (MDC) was calculated from SEM. RESULTS: The ICCs for PPTs ranged from 0.88-0.97, with SEM values ranging from 12.0 to 28.2 kPa and MDC ranging from 33.2 to 78.2 kPa. The ICCs for ROM ranged from 0.66-0.97, with SEM values ranging from 3.0 to 7.5° and MDC ranging from 8.4 to 20.8°. Finally, ICCs for MIMS ranged from 0.62-0.92, with SEM values ranging from 0.03 to 0.07 Nm/Kg FFM and MDC ranging from 0.09 to 0.19 Nm/kg FFM. CONCLUSION: The results of this study indicate that PPTs, ROM and MIMS can be measured reliably on the affected shoulder in BCS with pain after treatment. This offer the possibility of using these measures to assess the effectiveness of interventions in this population.


Assuntos
Neoplasias da Mama/terapia , Limiar da Dor , Dor/patologia , Ombro/fisiologia , Adulto , Índice de Massa Corporal , Neoplasias da Mama/patologia , Neoplasias da Mama/cirurgia , Feminino , Humanos , Força Muscular , Dor/etiologia , Amplitude de Movimento Articular , Autorrelato , Índice de Gravidade de Doença
10.
Biomed Khim ; 66(2): 151-155, 2020 Feb.
Artigo em Russo | MEDLINE | ID: mdl-32420896

RESUMO

The aim of the study was to determine the level of sex steroid hormones in white matter of the brain of rats with tumors combined with chronic neurogenic pain (CNP), which was modeled by bilateral sciatic nerve ligation. The study included albino male rats (n=74). In the main group, M1 sarcoma was transplanted subcutaneously (n=11) or into the subclavian vein (n=11) 45 days after CNP modeling. Two comparison groups (n=13 each) included sham operated animals (without CNP) with M1 sarcoma transplanted subcutaneously and intravenously. Control groups included animals with CNP and sham operated animals. Rats were euthanized on day 21 of the carcinogenesis. Levels of total and free testosterone (T), estrone (E1), estradiol (E2), estriol (E3) and progesterone (P4) in the brain white matter were measured using ELISA kits ("Cusabio", China). CNP caused a decrease in the total and free T by 1.5 times (p<0.05), E2 and P4 by 1.9 and 3 times, respectively, E3 by 1.6 times (p<0.05), as well as an increase in E1 by 1.4 times (p<0.05) as compared to the corresponding levels in the brain white matter of rats without CNP. CNP stimulated M1 sarcoma growth in both subcutaneous and intravenous transplantation. Regardless of the tumor site, the dynamics of total T, E2 and E3 in the brain had similar features, but the dynamics of free T, P4 and E1 differed. Thus, changes in the level of neurosteroids in the white matter of rat brain with CNP and tumor growth alone or associated with CNP are a reaction to stress.


Assuntos
Química Encefálica , Neoplasias Experimentais/patologia , Neuroesteroides/análise , Dor/patologia , Sarcoma/patologia , Animais , Estradiol , Estrona , Masculino , Transplante de Neoplasias , Progesterona , Ratos
11.
Sci Rep ; 10(1): 6569, 2020 04 16.
Artigo em Inglês | MEDLINE | ID: mdl-32300146

RESUMO

Tenascin-X (TNX) is a member of the extracellular matrix glycoprotein tenascin family, and TNX deficiency leads to Ehlers-Danlos syndrome, a heritable human disorder characterized mostly by skin hyperextensibility, joint hypermobility, and easy bruising. TNX-deficient patients complain of chronic joint pain, myalgia, paresthesia, and axonal polyneuropathy. However, the molecular mechanisms by which TNX deficiency complicates pain are unknown. Here, we examined the nociceptive behavioral responses of TNX-deficient mice. Compared with wild-type mice, TNX-deficient mice exhibited mechanical allodynia but not thermal hyperalgesia. TNX deficiency also increased pain sensitivity to chemical stimuli and aggravated early inflammatory pain elicited by formalin. TNX-deficient mice were significantly hypersensitive to transcutaneous sine wave stimuli at frequencies of 250 Hz (Aδ fiber responses) and 2000 Hz (Aß fiber responses), but not to stimuli at frequency of 5 Hz (C fiber responses). In addition, the phosphorylation levels of extracellular signal-related kinase, an active neuronal marker, and the activity of NADPH-diaphorase, a neuronal nitric oxide activation marker, were enhanced in the spinal dorsal horns of TNX-deficient mice. These results suggest that TNX deficiency contributes to the development of mechanical allodynia and hypersensitivity to chemical stimuli, and it induces hypersensitization of myelinated A fibers and activation of the spinal dorsal horn.


Assuntos
Síndrome de Ehlers-Danlos/complicações , Hiperalgesia/complicações , Tenascina/deficiência , Analgésicos/farmacologia , Analgésicos/uso terapêutico , Animais , Formaldeído , Hiperalgesia/tratamento farmacológico , Hiperalgesia/fisiopatologia , Masculino , Camundongos Endogâmicos C57BL , Dor/complicações , Dor/patologia , Dor/fisiopatologia , RNA Mensageiro/genética , RNA Mensageiro/metabolismo , Corno Dorsal da Medula Espinal/efeitos dos fármacos , Corno Dorsal da Medula Espinal/patologia , Corno Dorsal da Medula Espinal/fisiopatologia , Tenascina/genética , Tenascina/metabolismo
12.
J Urol ; 204(3): 518-523, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32223699

RESUMO

PURPOSE: We compared demographics, clinical presentation, comorbidities, urinary profiles, and treatment responses between patients with interstitial cystitis/bladder pain syndrome with and without Hunner lesions. MATERIALS AND METHODS: We performed a systematic review of the literature in PubMed® in February 2019. Publications were included if they compared data between patients with interstitial cystitis/bladder pain syndrome with and without Hunner lesions, yielding 59 articles. Meta-analysis was performed on a subset of clinical characteristics. RESULTS: Meta-analysis showed that patients with interstitial cystitis/bladder pain syndrome with Hunner lesions were significantly older (MD 6.7 years, 95% CI 2.0-11.3, p=0.005), reported higher urinary frequency (MD 3.2 per day, 95% CI 1.1-5.4, p=0.003), nocturia (MD 1.0 per night, 95% CI 0.1-2.0, p=0.034) and Interstitial Cystitis Symptom Index (MD 2.2, 95% CI 1.4-3.0, p <0.001), but lower cystometric bladder capacity (MD -113 ml, 95% CI -164 to -61 ml, p <0.001) compared to those with interstitial cystitis/bladder pain syndrome without Hunner lesions. There were no differences in pain scores (p=0.105), symptom duration (p=0.2) or sex (p=0.83) between the 2 groups. While some studies reported higher rates of comorbid pain syndromes (eg fibromyalgia) among patients without Hunner lesions, overall results were conflicting. Patients with Hunner lesions had higher urinary levels of pro-inflammatory cytokines/chemokines (CXCL10, NGF, IL-6, IL-8, MIF), luminal nitric oxide and responded well to endoscopic treatment of the Hunner lesions (eg fulguration or triamcinolone injection). In comparative studies patients with interstitial cystitis/bladder pain syndrome with Hunner lesions responded better to oral cyclosporine A than those without Hunner lesions. CONCLUSIONS: Systematic review and meta-analysis demonstrated significant differences in demographics, clinical presentation, urinary marker profiles, and treatment responses between patients with and without Hunner lesions, suggesting that they may represent 2 distinct clinical phenotypes. Studies are needed to investigate their mechanistic differences.


Assuntos
Cistite Intersticial/patologia , Dor/patologia , Bexiga Urinária/patologia , Biomarcadores/urina , Humanos , Medição da Dor , Fenótipo , Síndrome
13.
J Neurosci ; 40(18): 3517-3532, 2020 04 29.
Artigo em Inglês | MEDLINE | ID: mdl-32245829

RESUMO

One of the first signs of viral infection is body-wide aches and pain. Although this type of pain usually subsides, at the extreme, viral infections can induce painful neuropathies that can last for decades. Neither of these types of pain sensitization is well understood. A key part of the response to viral infection is production of interferons (IFNs), which then activate their specific receptors (IFNRs) resulting in downstream activation of cellular signaling and a variety of physiological responses. We sought to understand how type I IFNs (IFN-α and IFN-ß) might act directly on nociceptors in the dorsal root ganglion (DRG) to cause pain sensitization. We demonstrate that type I IFNRs are expressed in small/medium DRG neurons and that their activation produces neuronal hyper-excitability and mechanical pain in mice. Type I IFNs stimulate JAK/STAT signaling in DRG neurons but this does not apparently result in PKR-eIF2α activation that normally induces an anti-viral response by limiting mRNA translation. Rather, type I IFNs stimulate MNK-mediated eIF4E phosphorylation in DRG neurons to promote pain hypersensitivity. Endogenous release of type I IFNs with the double-stranded RNA mimetic poly(I:C) likewise produces pain hypersensitivity that is blunted in mice lacking MNK-eIF4E signaling. Our findings reveal mechanisms through which type I IFNs cause nociceptor sensitization with implications for understanding how viral infections promote pain and can lead to neuropathies.SIGNIFICANCE STATEMENT It is increasingly understood that pathogens interact with nociceptors to alert organisms to infection as well as to mount early host defenses. Although specific mechanisms have been discovered for diverse bacterial and fungal pathogens, mechanisms engaged by viruses have remained elusive. Here we show that type I interferons, one of the first mediators produced by viral infection, act directly on nociceptors to produce pain sensitization. Type I interferons act via a specific signaling pathway (MNK-eIF4E signaling), which is known to produce nociceptor sensitization in inflammatory and neuropathic pain conditions. Our work reveals a mechanism through which viral infections cause heightened pain sensitivity.


Assuntos
Viroses do Sistema Nervoso Central/metabolismo , Interferon Tipo I/toxicidade , Nociceptores/metabolismo , Limiar da Dor/fisiologia , Dor/metabolismo , Doenças do Sistema Nervoso Periférico/metabolismo , Animais , Células Cultivadas , Viroses do Sistema Nervoso Central/induzido quimicamente , Viroses do Sistema Nervoso Central/patologia , Feminino , Gânglios Espinais/efeitos dos fármacos , Gânglios Espinais/metabolismo , Gânglios Espinais/patologia , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Camundongos Knockout , Camundongos Transgênicos , Nociceptores/efeitos dos fármacos , Nociceptores/patologia , Dor/induzido quimicamente , Dor/patologia , Limiar da Dor/efeitos dos fármacos , Doenças do Sistema Nervoso Periférico/induzido quimicamente , Doenças do Sistema Nervoso Periférico/patologia
14.
Med Sci Monit ; 26: e921119, 2020 Apr 03.
Artigo em Inglês | MEDLINE | ID: mdl-32243427

RESUMO

BACKGROUND Percutaneous transforaminal endoscopic surgery has been used as a surgical measure for lumbar lateral recess stenosis. However, the necessary decompressive range has never been clearly documented in detail. Here, we discuss the effectiveness of a percutaneous transforaminal endoscopic procedure with clearly defined decompressive range. MATERIAL AND METHODS The relevant data were retrospectively collected from a series of degenerative lateral recess stenosis patients who acquired a prospectively designed percutaneous transforaminal endoscopic procedure in our department. The decompressive procedure mainly included undercutting of superior articular process and intervertebral disk annuloplasty. Leg pain and back pain was evaluated using visual analogue scale (VAS). The functional status was assessed using Oswestry disability index (ODI). The clinical results were also evaluated using MacNab criteria. RESULTS From May 2014 to October 2018, a total of 33 patients who met our inclusion criteria were included for analysis. There were no perioperative complications. Leg pain VAS decreased from preoperative score of 6.18±2.38 to final follow-up score of 0.45±1.00 (P<0.01). Back pain VAS decreased from preoperative score of 1.88±2.19 to final follow-up score of 0.64±1.02 (P<0.01). ODI (%) decreased from preoperative score of 47.86±18.15 to final follow-up score of 6.29±6.75 (P<0.01). At the final follow-up, the results of MacNab criteria were excellent in 18 cases (54.55%), good in 14 cases (42.42%), fair in 1 case (3.03%) and poor in 0 cases. None of the patients complained of recurrence of the symptoms during follow-up. CONCLUSIONS Undercutting of "superior articular process neck" plus intervertebral disk annuloplasty is sufficient for lumbar lateral recess decompression in a transforaminal approach.


Assuntos
Descompressão Cirúrgica/métodos , Disco Intervertebral/cirurgia , Estenose Espinal/cirurgia , Adulto , Idoso , Endoscopia/métodos , Feminino , Humanos , Região Lombossacral/cirurgia , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos , Dor/epidemiologia , Dor/patologia , Estudos Retrospectivos , Resultado do Tratamento , Escala Visual Analógica
15.
PLoS One ; 15(3): e0230079, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32142538

RESUMO

This study aimed to evaluate the analgesic efficacy of two dosage regimens using two different concentrations of buprenorphine in cats undergoing dental extractions. Twenty-three cats with oral disease (8.2 ± 2.2 years old; 4.9 ± 0.9 kg) were included in a prospective, blinded, randomized clinical trial. Cats randomly received either Simbadol (1.8 mg/mL; 0.24 mg/kg, subcutaneously, every 24h: SG, n = 11) or Vetergesic (0.3 mg/mL; 0.02 mg/kg, intramuscularly, every 8h: VG, n = 12) throughout the study. They were admitted at day 0, underwent oral examination/radiographs/treatment under general anesthesia (buprenorphine-propofol-isoflurane-meloxicam-local anesthetic blocks) at day 1 and discharged at day 4. Sedation and pain were scored using the dynamic interactive visual analog scale (day 1) and the Glasgow Composite Measure Pain Scale-Feline (CMPS-F; up to postoperative 8 hours at day 1, 8 am, 4 pm and midnight at days 2 and 3, and 8 am at day 4), respectively. Rescue analgesia was administered with hydromorphone (0.05 mg/kg intravenously on day 1 or 0.1 mg/kg intramuscularly after day 2) when CMPS-F ≥ 5. Resentment defined as any type of escape behavior associated with aversion to drug administration was recorded. Sedation and pain scores, the prevalence of rescue analgesia and resentment during drug administration were analyzed using linear mixed models and Fisher's exact test, respectively (p < 0.05). Pain and sedation scores were not significantly different between groups. Sedation scores were significantly higher up to postoperative 2 hours in both groups. Pain scores in SG and VG were significantly higher up to postoperative 8 hours and 8 am of day 2, respectively, than baseline. Prevalence of rescue analgesia and resentment were not significantly different between groups (SG: 27.3%, VG: 33.3% and SG: 0%, VG: 25%, respectively). Simbadol produced similar analgesic effects to Vetergesic without resentment during drug administration.


Assuntos
Analgesia/métodos , Analgésicos/administração & dosagem , Buprenorfina/administração & dosagem , Dor/patologia , Animais , Gatos , Método Duplo-Cego , Feminino , Masculino , Dor/veterinária , Doenças Periodontais/patologia , Doenças Periodontais/terapia , Doenças Periodontais/veterinária , Período Pós-Operatório , Estudos Prospectivos , Índice de Gravidade de Doença , Extração Dentária
16.
Nat Commun ; 11(1): 1397, 2020 03 13.
Artigo em Inglês | MEDLINE | ID: mdl-32170060

RESUMO

Gastrin-releasing peptide (GRP) functions as a neurotransmitter for non-histaminergic itch, but its site of action (sensory neurons vs spinal cord) remains controversial. To determine the role of GRP in sensory neurons, we generated a floxed Grp mouse line. We found that conditional knockout of Grp in sensory neurons results in attenuated non-histaminergic itch, without impairing histamine-induced itch. Using a Grp-Cre knock-in mouse line, we show that the upper epidermis of the skin is exclusively innervated by GRP fibers, whose activation via optogeneics and chemogenetics in the skin evokes itch- but not pain-related scratching or wiping behaviors. In contrast, intersectional genetic ablation of spinal Grp neurons does not affect itch nor pain transmission, demonstrating that spinal Grp neurons are dispensable for itch transmission. These data indicate that GRP is a neuropeptide in sensory neurons for non-histaminergic itch, and GRP sensory neurons are dedicated to itch transmission.


Assuntos
Peptídeo Liberador de Gastrina/genética , Peptídeo Liberador de Gastrina/metabolismo , Dor/metabolismo , Prurido/metabolismo , Células Receptoras Sensoriais/metabolismo , Medula Espinal/metabolismo , Animais , Modelos Animais de Doenças , Técnicas de Inativação de Genes , Histamina/metabolismo , Camundongos , Camundongos Endogâmicos C57BL , Camundongos Knockout , Neurotransmissores , Dor/patologia , Prurido/patologia , Células Receptoras Sensoriais/patologia , Pele/metabolismo , Pele/patologia , Transcriptoma
17.
PLoS One ; 15(3): e0230408, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32210442

RESUMO

BACKGROUND: Opioid overdose mortality continues to increase in the United States despite significant investments to reverse the epidemic. The national response to-date has focused primarily on reducing opioid prescribing, yet reductions in prescribing have been associated with patients reporting uncontrolled pain, psychological distress, and transition to illicit substances. The aim of this study is to qualitatively explore chronic pain management experiences among PLWH with a history of illicit substance use after long-term opioid therapy reductions or discontinuations. METHODS: We analyzed 18 interviews, stopping upon reaching thematic saturation, with HIV-positive participants with a history of substance use who were enrolled in a longitudinal cohort study to assess the impact of prescribing changes among patients with chronic pain. Participants in this nested qualitative study had been reduced/discontinued from opioid pain relievers (OPRs) within the 12 months prior to interview. Interviews were audio-recorded and transcribed verbatim. Two analysts coded all interviews, interrater reliability was measured, and coding discrepancies discussed. The study took place in San Francisco, California in 2018. RESULTS: Eleven participants were male with a mean age of 55; 8 were African American and 8 were White. All participants were HIV-positive, actively engaged in primary care, and had a lifetime history of illicit substance use. Twelve reported using illicit substances within the past year, including non-prescription opioids/heroin (10), and stimulant use (10). After being reduced/discontinued from their long-term opioid therapy, patients reported developing complex multimodal pain management systems that often included both nonpharmacological approaches and illicit substance use. Participants encountered a range of barriers to nonpharmacological therapies including issues related to accessibility and availability. Participants often reported attempts to replicate their prior OPR prescription by seeking out the same medication and dose from illicit sources and reported transitioning to heroin after exhausting other options. CONCLUSION: After being reduced/discontinued from OPRs, HIV-positive patients with a history of substance use reported experimenting with a range of pain management modalities including nonpharmacological therapies and illicit substance use to manage symptoms of opioid withdrawal and pain. Providers should consider that any change to a patients' long-term opioid therapy may result in experimentation with pain management outside of the medical setting and may want to employ patient-centered, holistic approaches when managing patients' opioid prescriptions and chronic pain.


Assuntos
Analgésicos Opioides/uso terapêutico , Infecções por HIV/tratamento farmacológico , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Dor/tratamento farmacológico , Acupuntura , Analgésicos Opioides/efeitos adversos , Prescrições de Medicamentos , Feminino , Infecções por HIV/patologia , Infecções por HIV/virologia , Heroína/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos Relacionados ao Uso de Opioides/patologia , Transtornos Relacionados ao Uso de Opioides/virologia , Dor/patologia , Dor/virologia , Manejo da Dor , São Francisco/epidemiologia , Pessoas Transgênero
18.
J Bone Miner Metab ; 38(4): 469-480, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32020290

RESUMO

INTRODUCTION: Cold intolerance is defined as abnormal pain resulting from exposure to cold stimulation after trauma. However, the pathophysiology remains unclear. We recently demonstrated that regional osteoporotic changes accompanied by high bone turnover were involved in causing pain-like behaviors in the unloaded hind limbs of tail-suspended mice. Bisphosphonate prevented pain-like behaviors and high bone turnover conditions in tail-suspended mice. The aims of this study were to examine the relationship between regional osteoporotic changes and the induction of hypersensitivity to cold stimulation. MATERIALS AND METHODS: The hind limbs of tail-suspended mice were unloaded for 2 weeks. The von Frey test and paw-flick test assessed pain-like behaviors and cold plate test evaluated cold escape behaviors. Furthermore, we examined whether cold hypersensitivity associated with regional osteoporotic changes could be improved by bisphosphonate, TRPV1 and TRPA1 antagonists. RESULTS: Hypersensitivity to cold stimulation was induced more noticeably in the tail-suspended mice, and this effect was related to the increased expression of bone metabolism markers. In addition, the cold hypersensitivity was improved by the resumption of weight bearing and prevented by bisphosphonate or a TRPV1 antagonist, and was accompanied with a decrease in the expression of bone metabolism markers. TRPA1 antagonist significantly improved the cold escape behavior, but had no significant effects on the expression of those markers. CONCLUSION: We demonstrated that the regional osteoporotic changes accompanying a high bone turnover state could be involved in the induction of hypersensitivity to cold stimulation in the tail-suspended mice.


Assuntos
Temperatura Baixa , Síndromes Periódicas Associadas à Criopirina/complicações , Elevação dos Membros Posteriores , Osteoporose/complicações , Animais , Comportamento Animal , Diferenciação Celular , Difosfonatos/uso terapêutico , Elevação dos Membros Posteriores/efeitos adversos , Masculino , Camundongos Endogâmicos C57BL , Osteoblastos/patologia , Osteoclastos/patologia , Osteoporose/tratamento farmacológico , Osteoporose/patologia , Dor/patologia , Pele/patologia , Medula Espinal/patologia , Canal de Cátion TRPA1/antagonistas & inibidores , Canal de Cátion TRPA1/metabolismo , Canais de Cátion TRPM/metabolismo , Canais de Cátion TRPV/antagonistas & inibidores , Canais de Cátion TRPV/metabolismo
19.
Qual Life Res ; 29(6): 1707-1719, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32020564

RESUMO

PURPOSE: To determine important symptoms and functional effects of venous malformations (VMs) to assess the content validity of commonly used patient-reported outcome (PRO) measures for use with VM patients. METHODS: This cross-sectional, qualitative study involved cognitive interviews with participants with VM aged ≥ 14 years. From February to June 2016, 11 participants (8 female) with a mean (± standard deviation) age of 31 ± 15 years were recruited from three clinical sites. The following subgroups were evaluated: 5 adults (aged ≥ 18) with trunk/extremity VMs; 3 adolescents (aged 14-17) with trunk/extremity VMs; and 3 adults with head/neck VMs. We evaluated the content validity of the Worst Pain Numeric Rating Scale (NRS), Patient-Reported Outcomes Measurement Information System (PROMIS®) Pain Interference 8-item short form, and PROMIS Physical Function 8-item short form. RESULTS: The most common participant-reported VM symptoms were swelling (n = 10), skin discoloration (n = 8), acute episodic pain (n = 8), chronic pain (n = 7), numbness (n = 7), and tingling/burning (n = 6). Participants reported that VMs affected their physical function (n = 10), appearance (n = 10), relationships/social activities (n = 7), and emotional health (n = 3). The Worst Pain NRS and PROMIS Pain Interference measures were relevant to all participants' VM experience. Only adults with head/neck VMs found the PROMIS Physical Function measure to be irrelevant. The assessed PRO measures did not address several symptoms commonly reported by VM patients (swelling, skin discoloration, numbness, and appearance). CONCLUSION: These results suggest that several VM symptoms are not assessed fully by commonly used PRO measures, and that the relevance of functional limitation questions may vary by VM location.


Assuntos
Malformações Arteriovenosas/psicologia , Medidas de Resultados Relatados pelo Paciente , Qualidade de Vida/psicologia , Adolescente , Adulto , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Dor/patologia , Medição da Dor/métodos , Pesquisa Qualitativa , Escleroterapia/métodos , Adulto Jovem
20.
Exp Brain Res ; 238(3): 751-759, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32086551

RESUMO

There is evidence of testosterone having deteriorating effects on cognitive and affective empathic behaviour in men and women under varying conditions. However, whether testosterone influences empathy for pain has not yet been investigated. Therefore, we tested neural responses to witnessing others in pain in a within-subject placebo-controlled testosterone administration study in healthy young women. Using functional magnetic resonance imaging, we provide affirming evidence that an empathy-inducing paradigm causes changes in the activity throughout the pain circuitry, including the bilateral insula and anterior cingulate cortex. Administration of testosterone, however, did not influence these activation patterns in the pain matrix. Testosterone has thus downregulating effects on aspects of empathic behaviour, but based on these data does not seem to influence neural responses during empathy for others' pain. This finding gives more insight into the role of testosterone in human empathy.


Assuntos
Córtex Cerebral/fisiologia , Emoções/fisiologia , Dor/fisiopatologia , Adolescente , Adulto , Mapeamento Encefálico/métodos , Empatia/fisiologia , Feminino , Giro do Cíngulo/fisiologia , Humanos , Imagem por Ressonância Magnética/métodos , Dor/patologia , Estimulação Luminosa/métodos , Adulto Jovem
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