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1.
Medicine (Baltimore) ; 100(35): e26873, 2021 Sep 03.
Artigo em Inglês | MEDLINE | ID: mdl-34477120

RESUMO

ABSTRACT: Meloxicam is commonly administrated to control postoperative pain in orthopedic surgery, while its efficacy in total knee arthroplasty (TKA) is not clear. Therefore, this study aimed to explore the postoperative analgesic effect and tolerance of meloxicam in knee osteoarthritis (OA) patients undergoing TKA.Totally, 128 knee OA patients scheduled for TKA were enrolled in this randomized, controlled, double-blind study, then randomized into meloxicam group (N = 65) and control group (N = 63) as 1:1 ratio. Patients took meloxicam or placebo from 4 hours (h) to 72 h after TKA. Patients were followed up at 6 h, 12 h, day (D)1, D2, D3, D7, month (M)1, and M3.Pain visual analog scale score at rest was decreased in meloxicam group at 12 h, D1 and D3 compared to control group; pain visual analog scale score at flexion was reduced in meloxicam group at 6 h, 12 h, D1, D2, and D3 compared to control group. Additional and total consumption of patient-controlled analgesia were both attenuated in meloxicam group compared to control group. Furthermore, patient satisfaction score was higher on D1, D2, D3 in meloxicam group compared to control group. However, no difference of hospital for special surgery knee score score at M1 or M3 was found between the 2 groups. Moreover, the occurrence of adverse events was similar between the 2 groups.Meloxicam displays good effect on controlling postoperative pain and improving patient satisfaction, while does not affect long-term knee function recovery or safety profile in knee OA patients undergoing TKA.


Assuntos
Meloxicam/normas , Osteoartrite do Joelho/tratamento farmacológico , Idoso , Anti-Inflamatórios não Esteroides/normas , Anti-Inflamatórios não Esteroides/uso terapêutico , Artroplastia do Joelho/métodos , Artroplastia do Joelho/estatística & dados numéricos , Distribuição de Qui-Quadrado , Método Duplo-Cego , Feminino , Humanos , Masculino , Meloxicam/uso terapêutico , Pessoa de Meia-Idade , Manejo da Dor/métodos , Manejo da Dor/estatística & dados numéricos , Medição da Dor/métodos , Recuperação de Função Fisiológica
2.
Best Pract Res Clin Anaesthesiol ; 35(3): 307-319, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34511221

RESUMO

Telemedicine is the medical practice of caring for and treating patients remotely. With the spread of the coronavirus disease-2019 (COVID-19) pandemic, telemedicine has become increasingly prevalent. Although telemedicine was already in practice before the 2020 pandemic, the internet, smartphones, computers, and video-conferencing tools have made telemedicine easily accessible and available to almost everyone. However, there are also new challenges that health care providers may not be prepared for, including treating and diagnosing patients without physical contact. Physician adoption also depends upon reimbursement and education to improve the telemedicine visits. We review current trends involving telemedicine, how pandemics such as COVID-19 affect the remote treatment of patients, and key concepts important to healthcare providers who practice telemedicine.


Assuntos
COVID-19/prevenção & controle , Pessoal de Saúde/tendências , Padrões de Prática Médica/tendências , Telemedicina/tendências , COVID-19/diagnóstico , COVID-19/epidemiologia , Humanos , Manejo da Dor/métodos , Manejo da Dor/tendências , Pandemias/prevenção & controle , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/terapia , Telemedicina/métodos
3.
Rev Assoc Med Bras (1992) ; 67(4): 585-589, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-34495065

RESUMO

OBJECTIVE: The aim of this study was to evaluate the efficacy of high-voltage pulsed radiofrequency in comparison with standard-voltage pulsed radiofrequency for the treatment of elderly patients with acute herpes zoster neuralgia. METHODS: Sixty-four elderly acute herpes zoster neuralgia patients were randomly assigned to the standard-voltage pulsed radiofrequency group (i.e., group S, 32 cases) and the high-voltage pulsed radiofrequency group (i.e., group H, 32 cases), which received the standard-voltage and high-voltage pulsed radiofrequency treatment, respectively. The doses of gabapentin and tramadol for analgesia were adjusted based on pain degree of patients. The therapeutic effectiveness were assessed using the numeric rating scale and the sleep quality scale. The doses of gabapentin and tramadol before pulsed radiofrequency and 1, 2, 4, 8, and 12 weeks after pulsed radiofrequency were measured. The incidence of clinically meaningful postherpetic neuralgia (pulsed radiofrequency) 12 weeks after pulsed radiofrequency was noted. RESULTS: After pulsed radiofrequency, the numeric rating scale score and the doses of gabapentin and tramadol in group H were significantly lower than those in group S, respectively (p<0.05). The sleep quality scale score in group H was significantly higher than that in group S (p<0.05). The incidence of clinically meaningful pulsed radiofrequency in group H was significantly lower than that in group S (p<0.05). CONCLUSION: For the treatment of elderly patients with acute herpes zoster neuralgia, when compared with the standard-voltage pulsed radiofrequency, the high-voltage pulsed radiofrequency can rapidly and steadily reduce the pain degree, improve the sleep quality, reduce the doses of anticonvulsants and analgesics, and decrease the incidence of clinically meaningful postherpetic neuralgia.


Assuntos
Herpes Zoster , Neuralgia Pós-Herpética , Neuralgia , Tratamento por Radiofrequência Pulsada , Idoso , Herpes Zoster/complicações , Humanos , Neuralgia Pós-Herpética/terapia , Manejo da Dor
4.
Shanghai Kou Qiang Yi Xue ; 30(3): 302-305, 2021 Jun.
Artigo em Chinês | MEDLINE | ID: mdl-34476450

RESUMO

PURPOSE: To evaluate the safety and efficacy of sedation and analgesia using dexmedetomidine combined with flurbiprofen axetil in multiple complex teeth extraction under local anesthesia. METHODS: According to the inclusion and exclusion criteria of the study, 40 patients scheduled for multiple complex teeth (4-6) extraction were randomly divided into 2 groups: experimental group (sedation and analgesia using dexmedetomidine combined with flurbiprofen axetil in addition to local anesthesia, n=20) and control group (local anesthesia, n=20). The mean arterial pressure(MAP), heart rate(HR), Ramsay sedation score, VAS pain score of each patient at T0(basis value), T1 (during local anesthesia), T2(during extraction), T3(10 minutes after extraction) and the follow-up results were recorded. SAS 8.0 software was used for statistical analysis. RESULTS: Compared to T0 and control group at the same time, the experimental group revealed more stable mood and hemodynamic manifestation and better analgesic effect (P<0.05), from T1 to T3, patients in the control group showed increased blood pressure, heart rate, emotional fluctuation, bodily and facial pain(P<0.05). The follow-up results showed 5 and 0 patients taking painkillers in the control and experimental group, respectively(P<0.05). CONCLUSIONS: Sedation and analgesia using dexmedetomidine combined with flurbiprofen axetil in addition to local anesthesia is a safe and effective approach in multiple complex teeth extraction.


Assuntos
Dexmedetomidina , Flurbiprofeno , Anestesia Local , Dexmedetomidina/uso terapêutico , Flurbiprofeno/análogos & derivados , Flurbiprofeno/uso terapêutico , Humanos , Manejo da Dor
5.
Rev Bras Enferm ; 74(5): e20200761, 2021.
Artigo em Inglês, Português | MEDLINE | ID: mdl-34468546

RESUMO

OBJECTIVE: Describe the actions implemented for pain management in palliative care oncology and analyze the contribution of Hospital do Câncer IV, as a reference unit at the National Cancer Institute. METHODS: Study of the history of the present time, whose sources were written documents and interviews with five participants. The collection took place from February to June 2018. The analysis of the written sources took place through internal and external criticism of the documents, considering their chronology and theme. RESULTS: Professionals contributed with actions for pain management in palliative oncology care: in discussions and final drafting of ordinances, as rapporteurs at national and international events, in the elaboration of humanization conducts and systematization of assistance in addressing pain. FINAL CONSIDERATIONS: These actions favored assistance in palliative oncology care at various levels of health care for patients and families, with greater technical and scientific recognition for all.


Assuntos
Neoplasias , Cuidados Paliativos , Humanos , Oncologia , Neoplasias/complicações , Neoplasias/terapia , Dor , Manejo da Dor
6.
Artigo em Alemão | MEDLINE | ID: mdl-34507381

RESUMO

Many surgical procedures are followed by postoperative pain. Acute pain should be treated optimally for medical and ethical reasons. Different psychological, physical, interventional and pharmacological methods are employed in a procedure specific and institution specific matter. For optimum patient care, implementation of acute pain management concepts in recommendations on quality management in German hospitals and outpatient clinics was enacted in September 2020 by Gemeinsamer Bundessausschuss (G-BA). Implementation of discharge management had already been enacted in 2017 for structured prescription of medication after hospital discharge, among other things. On the other hand, new national and international developments require a new weighting of pharmacotherapy in particular. Examples include debates on the safe use of metamizol and the opioid crisis in the US. To address these issues adjustments in informed consent and patient information and education are necessary. This includes also the information and education of caregivers. This article describes the legal framework, technical solutions and the impact of placebo and nocebo effects on doctor-patient communication.


Assuntos
Manejo da Dor , Alta do Paciente , Humanos , Consentimento Livre e Esclarecido , Dor Pós-Operatória/tratamento farmacológico , Relações Médico-Paciente
7.
Artigo em Alemão | MEDLINE | ID: mdl-34507382

RESUMO

Acute pain therapy following operative or interventional procedures has become a compulsory component of a modern perioperative patient management. A structured pain regimen has several clear advantages: it leads to an improvement of the patients' quality of life in the short term, it reduces perioperative morbidity in the medium term, it reduces pain chronification in the long term, at the same time improving the economic efficiency due to an accelerated mobilization, a reduction of the hospitalization and an avoidance of complication inherent costs.This article provides detailed information on the change of paradigm, away from a generalized and rather unspecific acute pain therapy towards a problem oriented procedure specific regimen. It points out two examples of the PROSPECT (PROcedure SPECific pain managemenT) methodology and explains its background.


Assuntos
Manejo da Dor , Qualidade de Vida , Humanos , Dor
8.
Artigo em Alemão | MEDLINE | ID: mdl-34507383

RESUMO

For many years now, effective pharmacological and non-pharmacological treatment approaches for acute and chronic pain exist, as well as organisational strategies for their implementation in hospitals. Nevertheless, there remain considerable deficits in pain management and the portion of patients with severe or long-lasting pain in non-surgical units is often high. There is a considerable potential to improve quality and structures of pain mangement in non-surgical hospital settings in Germany. Recently, legal requirements to establish a structured perioperative pain management were introduced. This should not be seen as a signal that pain management is less important in non-surgical disciplines. On the contrary - it should raise awareness for more clinical and health services research to further develop and validate appropriate approaches and concepts to improve pain treatment in this field.


Assuntos
Manejo da Dor , Dor , Alemanha , Hospitais , Humanos , Medição da Dor
9.
Artigo em Alemão | MEDLINE | ID: mdl-34507384

RESUMO

The number of non-surgical patients in the hospital setting with pain due to medical conditions or comorbidities and/or invasive procedures or treatments is high. Compared to perioperative pain management, the portion of patients and/or conditions that require more than an approach focused on pharmacological treatment of nociceptive pain is considerably higher. Rather, treatment often requires the differentiated use of co-analgesics, non-pharmacological treatments, physiotherapy, occupational therapy, psychological assessment and interventsions and educational approaches, ideally in the form of closely coordinated interdisciplinary treatment. The assessment and treatment of acute and especially chronic pain should follow the biopsychosocial concept of pain, especially if risk factors for chronification have been identified, if patients receive high-dose therapy with analgesics or have preexisting a chronic pain disorder.


Assuntos
Dor Crônica , Manejo da Dor , Analgésicos/uso terapêutico , Dor Crônica/terapia , Humanos , Pacientes Internados , Medição da Dor
10.
J Opioid Manag ; 17(7): 33-41, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34520024

RESUMO

OBJECTIVE: This study compared opioid utilization and clinical outcomes in surgical patients receiving maintenance buprenorphine therapy who discontinued versus those who continued buprenorphine treatment perioperatively. Lack of high-quality evidence, conflicting results in previous studies, and the possible need for reinduction after discontinuing therapy present clinicians with the complicated dilemma of choosing the best strategy to control post-operative pain in patients receiving buprenorphine. DESIGN: A multicenter, retrospective cohort study. PARTICIPANTS: Hospitalized patients between January 1, 2017 and December 12, 2019 who underwent any type of surgery, had a documentation of an outpatient buprenorphine prescription or inpatient order, and received buprenorphine for 5 or more days prior to the procedure were included. MAIN OUTCOME MEASURE(S): The primary objective was to compare mean 24-hour morphine milligram equivalent (MME) utilization post-operatively between patients who discontinued buprenorphine preoperatively versus those who continued therapy throughout the perioperative period. RESULTS: Fifty-one patients met the inclusion criteria for this study. Of these, 42 patients were continued on buprenorphine through surgery, while nine patients had a documentation of discontinuation preoperatively. The 24-hour post-operative MME utilization (interquartile range) was 58.8 (18-100.8) in patients who continued therapy through surgery versus 152.6 (114.5-236) in patients who discontinued therapy preoperatively (p = 0.005). There were no significant differences in post-operative pain scores or length of stay between groups. CONCLUSION: Post-operative opioid use was significantly lower in patients who continued buprenorphine compared with those who discontinued buprenorphine preoperatively.


Assuntos
Buprenorfina , Transtornos Relacionados ao Uso de Opioides , Analgésicos Opioides/efeitos adversos , Buprenorfina/efeitos adversos , Humanos , Transtornos Relacionados ao Uso de Opioides/diagnóstico , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Transtornos Relacionados ao Uso de Opioides/prevenção & controle , Manejo da Dor , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/tratamento farmacológico , Estudos Retrospectivos
11.
J Opioid Manag ; 17(7): 101-107, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34520031

RESUMO

There is limited evidence and no clear consensus suggesting best practices for perioperative buprenorphine management in patients with opioid use disorder. As such, we aimed to develop a standardized perioperative management approach with the goals of (1) optimizing perioperative analgesia, (2) minimizing relapse risk, (3) setting expectations for patients and clinicians, (4) achieving prescribing consistency and mitigating risk among clinicians not familiar with perioperative buprenorphine management, and (5) maintaining continuity throughout care transitions. An interprofessional expert focus group convened to develop a consensus algorithm based upon buprenorphine's unique pharmacologic features and published perioperative management recommendations. The resulting consensus algorithm continues the patient's home buprenorphine dose in order to minimize relapse risk, but utilizes a divided dose approach starting the day of surgery if moderate to severe post-operative pain is expected. This strategy leverages the analgesic effects of buprenorphine while allowing for additional opioid binding to optimize analgesia. A patient-centered multimodal perioperative approach including local and/or regional anesthetics and nonopioid adjuncts is employed. Post-operative care is optimized by preoperative planning, including standardized patient assessment, perioperative communication with the buprenorphine prescriber, and education for patients and clinicians. Overall, integrating an understanding of pharmacology and clinical impact through the use of a readily adaptable algorithm such as the divided dose approach is key to optimizing patient care in this high-risk population.


Assuntos
Buprenorfina , Transtornos Relacionados ao Uso de Opioides , Analgésicos Opioides/efeitos adversos , Buprenorfina/efeitos adversos , Humanos , Transtornos Relacionados ao Uso de Opioides/diagnóstico , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Transtornos Relacionados ao Uso de Opioides/prevenção & controle , Manejo da Dor , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/prevenção & controle
12.
J Opioid Manag ; 17(7): 153-158, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34520036

RESUMO

We report a case in which sublingual buprenorphine was used to help transition a patient off intravenous (IV) opioid analgesics medications post-multiple abdominal procedures. Intravenous opioids are commonly used in inpatient surgical pain management for patients with severe pain who are unable to take oral medications. Typically, a short course of IV analgesics is used, followed by transition to oral analgesic regimen. However, in patients with poor gastrointestinal absorption, pain control can be challenging. We present this case to highlight how sublingual buprenorphine can be a useful agent for acute pain management, especially when conventional strategies provide suboptimal responses.


Assuntos
Analgésicos Opioides , Buprenorfina , Analgésicos Opioides/efeitos adversos , Buprenorfina/efeitos adversos , Combinação Buprenorfina e Naloxona , Humanos , Dor , Manejo da Dor
13.
Lakartidningen ; 1182021 Sep 07.
Artigo em Sueco | MEDLINE | ID: mdl-34498236

RESUMO

Pain rehabilitation is a process starting with a pain analysis to find an adequate pain diagnosis, a classification based on pain mechanisms and a mapping of the psychological and social situation of the patient. These factors are the basis for the treatment plan. Monodisciplinary treatments such as pharmacological treatments, physiotherapy, or psychological therapy, should be tested first if judged to improve the overall situation in a permanent manner. Patients with a complex situation can be subject to pain rehabilitation (interdisciplinary multimodal pain rehabilitation, IMMPR). IMMPR involves a coordinated effort of healthcare professionals with expertise in pain management aiming to reduce psychological distress, increase work ability and return to normal social activities and improve general health and life quality. Follow-up of patients undergoing IMMPR is routinely done by means of the Swedish Quality Registry for Pain Rehabilitation (SQRP), including rehabilitation in Primary Care and at specialized pain units.


Assuntos
Dor Crônica , Manejo da Dor , Humanos , Atenção Primária à Saúde , Qualidade de Vida , Sistema de Registros
14.
Rev Esc Enferm USP ; 55: e20200513, 2021.
Artigo em Inglês, Português | MEDLINE | ID: mdl-34515722

RESUMO

OBJECTIVE: To assess the effect of virtual reality in pain relief during chronic wound dressing change. METHOD: This is an experimental study carried out with 17 participants, in a stomatherapy clinic in Ceará, Brazil, from June to December 2019, using the virtual reality glasses Oculus Go®. Sociodemographic and clinical information, as well as of lifestyle, and characteristics of the lesions were collected. A faces scale and a visual analogue scale were used for pain assessment, behavioral aspects assessment, satisfaction, and discomfort with Oculus Go®. The Chi-square, McNemar, and Wilcoxon tests were used. The study was approved under opinion No. 2.649.144/2019. RESULTS: There was a reduction in pain during dressing change with Oculus Go®. Participants with Oculus Go® manifested less pain during (p < 0.001) and after (p < 0.001) dressing change; and had lower heart rate before (p = 0.044) and after (p = 0.001) the procedure. There were significant differences between groups in systolic (p = 0.012) and diastolic (p = 0.004) blood pressure values after dressing. Virtual reality did not cause any discomfort and participants were satisfied. CONCLUSION: Virtual reality showed positive effects in pain relief during chronic wound dressing change.


Assuntos
Realidade Virtual , Bandagens , Humanos , Dor , Manejo da Dor , Medição da Dor
15.
Orv Hetil ; 162(38): 1511-1519, 2021 09 19.
Artigo em Húngaro | MEDLINE | ID: mdl-34537716

RESUMO

Összefoglaló. Az új koronavírusként megismert SARS-CoV-2-fertozés legsúlyosabb szövodményeként a gyulladásos folyamatok jelátvivo molekuláinak elszabadulása - az ún. citokinvihar - kritikus légzési elégtelenséggel társuló akut respirációs diszfunkciós szindrómát vagy többszervi gyulladásos szindrómát okoz. Mostanáig igazolódott, hogy a fertozések legnagyobb részben tünetmentesen vagy enyhe tünetekkel zajlanak. A betegség minden szakaszában elofordulhat enyhe vagy középsúlyos, ritkábban intenzív fájdalom, melyek enyhítésére számos fájdalomcsillapítási lehetoség áll rendelkezésre. A pandémia kezdete óta foglalkoznunk kell a tünetek enyhítésével, akár infektológiai osztályon, akár mutéti ellátás alkalmával. A betegek hazaengedését követoen figyelmet kell fordítanunk az intenzív osztályos ellátás utáni és a COVID-19-et követo tünetek és fájdalmak értékelésére. Idoszeru átfogó összefoglalónkban hangsúlyozzuk a különbözo fájdalomcsillapítók szerepét a COVID-19-fertozéssel összefüggo fájdalommal járó folyamatokban. Orv Hetil. 2021; 162(38): 1511-1519. Summary. As the most severe consequence of the new coronavirus SARS-CoV-2 infection, the cytokine storm - caused by the liberalization of several inflammatory mediators - engenders critical respiratory dysfunction syndrome or multisystem inflammatory syndrome. The most proportion of infections has proven symptomless or with very mild signs of disease so far. Mild, moderate, or rarely intense pain can occur in every phase of the disease, for the treatment of which more than a few analgesic possibilities are readily available. From the start of the pandemic, we have been concerning to ameliorate the symptoms, in either the department of infectology, or operating suites. The post-intensive care pain and post-COVID symptoms should be evaluated and treated after discharge. In this timely and comprehensive article, the role and importance of different analgesics are articulated regarding the COVID-associated painful conditions. Orv Hetil. 2021; 162(38): 1511-1519.


Assuntos
COVID-19 , SARS-CoV-2 , Humanos , Dor , Manejo da Dor , Pandemias
16.
Clin Drug Investig ; 41(9): 817-823, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34368943

RESUMO

BACKGROUND AND OBJECTIVE: Ketamine is an N-methyl-D-aspartate receptor (NMDA) antagonist used widely as an intravenous analgesic for treatment of acute pain. Its use as oral and sublingual analgesics is not well studied. This study aims to compare the clinical efficacy and tolerability of oral (PO) versus sublingual (SL) ketamine lozenges in adult patients with moderate-to-severe breakthrough pain. METHODS: The study had a randomized, double-blind crossover design in 23 inpatients requiring ketamine as rescue analgesics when pain scores exceeded 4/10 on the Numerical Rating Scales. Each participant received either SL 50 mg ketamine lozenge and PO placebo lozenge or SL placebo lozenge and PO 50 mg ketamine lozenge in two treatment periods with a minimum 24-h washout. Pain scores and adverse effects were documented half hourly for the first 2 h, then one hourly for the next 2 h after treatment. The time to first effect and time to meaningful pain relief were recorded. Patients reported their satisfaction and a global impression of change (GIC) at the end of each treatment period. Data were analysed using random effects regression models. RESULTS: Sixteen subjects completed both days, 7 completed 1 day. Time to first effect was 13.1 min PO versus 6.6 min SL (p = 0.069), time to meaningful pain relief was 29.4 min PO versus 10.8 min SL (p = 0.02). Pain scores were not significantly different at all time points post-treatment. Satisfaction and GIC scores were similar for both groups. Overall, adverse events occurred more often with SL administration (p = 0.02). CONCLUSIONS: Sublingual administration of ketamine led to a faster onset of pain relief (but also a higher adverse event rate), but in all other aspects treatment with ketamine given sublingually and orally produced similar analgesic effects. ACTRN: ACTRN12621000240842, 08/03/2021, retrospectively registered.


Assuntos
Dor Aguda , Ketamina , Dor Aguda/diagnóstico , Dor Aguda/tratamento farmacológico , Administração Sublingual , Adulto , Analgésicos/uso terapêutico , Analgésicos Opioides/uso terapêutico , Método Duplo-Cego , Humanos , Ketamina/uso terapêutico , Manejo da Dor , Resultado do Tratamento
17.
19.
FASEB J ; 35(9): e21332, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34423867

RESUMO

Emerging research has highlighted the capacity of microRNA-23a-3p (miR-23a-3p) to alleviate inflammatory pain. However, the molecular mechanism by which miR-23a-3p attenuates inflammatory pain is yet to be fully understood. Hence, the current study aimed to elucidate the mechanism by which miR-23a-3p influences inflammatory pain. Bioinformatics was initially performed to predict the inflammatory pain related downstream targets of miR-23a-3p in macrophage-derived extracellular vesicles (EVs). An animal inflammatory pain model was established using Complete Freund's Adjuvant (CFA). The miR-23a-3p expression was downregulated in the microglia of CFA-induced mice, after which the inflammatory factors were determined by ELISA. FISH and immunofluorescence were performed to analyze the co-localization of miR-23a-3p and microglia. Interestingly, miR-23a-3p was transported to the microglia via M2 macrophage-EVs, which elevated the mechanical allodynia and the thermal hyperalgesia thresholds in mice model. The miR-23a-3p downstream target, USP5, was found to stabilize HDAC2 via deubiquitination to promote its expression while inhibiting the expression of NRF2. Taken together, the key findings of the current study demonstrate that macrophage-derived EVs containing miR-23a-3p regulates the HDAC2/NRF2 axis by decreasing USP5 expression to alleviate inflammatory pain, which may provide novel therapeutic targets for the treatment of inflammatory pain.


Assuntos
Vesículas Extracelulares/metabolismo , Histona Desacetilase 2/metabolismo , Inflamação/metabolismo , Macrófagos/citologia , Fator 2 Relacionado a NF-E2/metabolismo , Dor/metabolismo , Proteases Específicas de Ubiquitina/metabolismo , Animais , Linhagem Celular , Enzimas Desubiquitinantes/metabolismo , Modelos Animais de Doenças , Regulação para Baixo , Estabilidade Enzimática , Vesículas Extracelulares/genética , Inflamação/genética , Inflamação/terapia , Macrófagos/metabolismo , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Microglia/citologia , Microglia/metabolismo , Modelos Biológicos , Dor/genética , Manejo da Dor , Proteases Específicas de Ubiquitina/genética , Ubiquitinação
20.
Isr Med Assoc J ; 23(8): 534-540, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34392634

RESUMO

BACKGROUND: Diagnosis and treatment of posterior hip pain has increased due to advancements in clinical, anatomical, biomechanical, and related pathological understandings of the hip. Due to its complexity and close anatomical relationship with many osseous, neurovascular, and musculotendinous structures, posterior hip pain must be appropriately categorized based on its origin. Therefore, it is crucial that clinicians are able to determine whether patient complaints are of extra-articular or intra-articular nature so that they can implement the optimal treatment plan. In the current review article, we discussed posterior hip pain with an emphasis on the main differential diagnoses of deep gluteal syndrome, ischiofemoral impingement, and hamstring tear/hamstring syndrome. For the appropriate diagnosis and etiology of posterior hip pain, a thorough and conclusive clinical history is imperative. Physicians should rule out the possibility of spinal involvement by physical examination and if necessary, by magnetic resonance imaging (MRI). Furthermore, because of the vicinity to other, non-orthopedic structures, an obstetric and gynecologic history, general surgery history, and urologic history should be obtained. Following the collection of patient history clinicians should adhere to an established and efficient order of evaluation starting with standing then to seated, supine, lateral, and prone testing. Imaging assessment of posterior hip pain begins with a standard anterior-posterior pelvic radiograph, in addition to frog-leg lateral. MRI is pivotal for assessing soft tissue-related extra-articular causes of hip in patients with posterior hip pain. Non-surgical treatment is preferred in most cases of deep gluteal syndrome, ischiofemoral impingement, pudendal nerve entrapment, and proximal hamstring pathologies. Surgical treatment is saved as a last resort option in cases of failed non-surgical treatment.


Assuntos
Quadril , Medição da Dor/métodos , Dor , Diagnóstico Diferencial , Quadril/diagnóstico por imagem , Quadril/patologia , Quadril/fisiopatologia , Humanos , Dor/diagnóstico , Dor/etiologia , Manejo da Dor/métodos , Planejamento de Assistência ao Paciente , Seleção de Pacientes
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