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1.
J Oral Sci ; 62(2): 147-149, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32224567

RESUMO

Pain can be divided into nociceptive, inflammatory, and neuropathic pain. It is important to understanding the molecular mechanism of pain signaling in the development of pain relief therapies. Twenty years ago, extracellular signal-regulated kinases (ERK) 1 and 2, which are members of the mitogen-activated protein kinase superfamily, were identified as molecules activated in neurons by the exposure of peripheral tissues to noxious stimuli. Further studies have revealed that peripheral nerve injury induces ERK activation in glial cells, sensory neurons, and second-order neurons, albeit at different time points. Moreover, inhibition of ERK suppresses pathological pain in animals with peripheral nerve injury. Therefore, ERK is currently recognized as an important molecule in pain signaling and a potential novel target for pain treatment. This review introduces recent advances in revealing the regulation of ERK in pain research.


Assuntos
MAP Quinases Reguladas por Sinal Extracelular , Neuralgia , Animais , Neuroglia , Neurônios Aferentes
2.
J Oral Sci ; 62(2): 160-164, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32224569

RESUMO

Neuropathic pain is characterized by sensory abnormalities, such as mechanical allodynia and heat hyperalgesia, associated with alteration in the peripheral and central nervous systems. After trigeminal nerve injury, phenotypic changes that involve the expression of calcitonin gene-related peptide occur in large- and medium-sized myelinated neurons; primary afferent neurons exhibit hyperexcitability because of neuron-glia interactions in the trigeminal ganglion. Increased nociceptive inputs from C- and Aδ-fiber and innocuous inputs from Aß-fiber into the trigeminal spinal subnucleus caudalis (Vc) contribute to the phenotypic changes; further, they potentiate noxious information transmission in the ascending nociceptive pathways to the thalamus and parabrachial nucleus (PBN). It is noteworthy that C-fiber mediated nociceptive inputs can activate both the Vc-ventral posteromedial thalamic nucleus and Vc-PBN pathways, while mechanoreceptive fiber inputs specifically activate the Vc-PBN pathway. The Vc-PBN pathways project to the central nucleus of the amygdala (CeA) where affective behaviors are modulated. In addition, the PBN interacts with wakefulness-regulating neurons and hunger-sensitive neurons in the hypothalamus, suggesting that the Vc-PBN pathway can modulate sleep and appetite. Therefore, phenotypic changes in primary neurons and stimulus modality-specific activation of ascending nociceptive pathways to the PBN may exacerbate affective aspects of trigeminal neuropathic pain, including behavioral problems, such as sleep disturbance and anorexia, via the PBN-CeA-hypothalamus circuits.


Assuntos
Neuralgia , Núcleos Parabraquiais , Peptídeo Relacionado com Gene de Calcitonina , Humanos , Neurônios
3.
Medicine (Baltimore) ; 99(11): e19101, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32176037

RESUMO

Mirror image sensory dysfunction (MISD) after breast surgery has not yet been studied. This prospective observational study aimed to determine the incidence of MISD, persistent postoperative pain (PPP) and mirror image pain (MIP) during 6 months after total unilateral mastectomy.Visual analogue scale (VAS), Neuropathic Pain Symptom Inventory (NPSI), Pain Catastrophizing Scale (PCS), Hospital Anxiety and Depression Scale (HADS), Life orientation test (LOT) and Quantitative Sensory Testing (QST) (in ipsi and contralateral breast, axilla and thigh) were recorded. VAS > 3 at 1, 3, and 6 postoperative months was considered PPP. Contralateral changes of QST at any time was considered indicative of MISD and spontaneous contralateral VAS ≥ 1 as MIP.Sixty-four patients were included. PPP at 1, 3 and 6 months was 18.8%, 56.2%, and 21.3%, respectively Ten patients presented MIP. MISD was detected in 79.7% patients in contralateral breast and 62.5% in contralateral axilla. Furthermore, changes in QST were present in 39.1% of patients in thigh. Electronic Von Frey (EVF) changes in both contralateral breast and axilla, and in thigh significantly diminished at all postoperative times. Changes of postoperative EVF ≥ 20% in contralateral breast were associated to higher VAS values. NPSI scores were significantly higher at all postoperative times. At 1 month, PCS, depression HADS subscale and LOT scores were significantly worse than all the other periods.MISD incidence was almost 80%, and 15.6% of patients showed spontaneous contralateral VAS ≥ 1. At 6 months 21.3% of patients manifested PPP. The worst alteration of factors related to PPP occurred at 1 postoperative month. Most consistent QST was EVF.


Assuntos
Mastectomia/efeitos adversos , Neuralgia/etiologia , Dor Pós-Operatória/etiologia , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Neuralgia/epidemiologia , Medição da Dor , Dor Pós-Operatória/epidemiologia , Estudos Prospectivos , Inquéritos e Questionários
4.
Dent Clin North Am ; 64(2): 379-399, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32111276

RESUMO

Burning mouth syndrome/glossodynia and trigeminal neuropathic conditions can have serious negative impact on a patient's overall quality of life. These conditions are often hard to diagnose and even harder to fully treat and manage, but it is important for dentists/oral and maxillofacial surgeons to be aware of these conditions and modalities of their treatment. Often the only method for arriving at the proper diagnosis is for patients to undergo traditional approaches for treatment of presenting signs and symptoms, and it is the unexpected failure of interventional therapies that leads ultimately to a proper diagnosis.


Assuntos
Síndrome da Ardência Bucal , Glossalgia , Neuralgia , Odontólogos , Humanos , Qualidade de Vida
5.
J Oral Sci ; 62(2): 165-169, 2020 Mar 28.
Artigo em Inglês | MEDLINE | ID: mdl-32161235

RESUMO

Burning mouth syndrome (BMS) is one of the most frequently seen idiopathic pain conditions in a dental setting. Peri- and postmenopausal women are most frequently affected, and patients who experience BMS complain of persistent burning pain mainly at the tip and the bilateral border of the tongue. Recent studies have assessed whether BMS is a neuropathic pain condition, based on morphologic changes in biopsied tongue specimens, and whether there are abnormal pain responses in patients with this disease. Somatosensory studies have reported some abnormal findings in sensory and pain detection thresholds with inconsistency; however, the most distinct finding was exaggerated responses to painful stimuli. Imaging and electrophysiologic studies have suggested the possibility of dysregulation of the pain-modulating system in the central nervous system, which may explain the enhanced pain responses despite the lack of typical responses toward quantitative sensory tests. Basic studies have suggested the possible involvement of neuroprotective steroids, although the underlying mechanisms of this condition have not been elucidated. Experimental studies are looking for preferable supportive therapies for BMS patients despite the obscure pathogenesis.


Assuntos
Síndrome da Ardência Bucal , Neuralgia , Feminino , Humanos , Limiar da Dor , Língua
7.
Internist (Berl) ; 61(3): 270-276, 2020 Mar.
Artigo em Alemão | MEDLINE | ID: mdl-32030435

RESUMO

BACKGROUND: The treatment of polyneuropathy includes symptomatic therapy of sensory, motor and autonomic dysfunctions. AIM: This article provides an overview of the current treatment recommendations for polyneuropathy, focusing on pain. METHODS: Current treatment guidelines will be discussed based on a literature research. RESULTS: Calcium-channel anticonvulsants gabapentin/pregabalin as well as antidepressants duloxetine and amitriptyline are recommended as first line therapeutics. Alternatively, topical therapeutics can be used in the case of localized disorders. In individual cases, opioids or other antidepressants/anticonvulsants may be effective. Pharmacological treatment is often limited due to adverse events, which affect the central nervous system in particular. DISCUSSION: In general, treatment for polyneuropathy should follow a multimodal concept and include the treatment of other symptoms. When choosing pain medication, comorbidities, patient's age and adverse events need to be taken into consideration. Phenotype-based stratification may support specialized pain therapy and achieve the best medical treatment.


Assuntos
Anticonvulsivantes/uso terapêutico , Antidepressivos/uso terapêutico , Neuralgia/tratamento farmacológico , Polineuropatias/tratamento farmacológico , Amitriptilina/uso terapêutico , Analgésicos/uso terapêutico , Bloqueadores dos Canais de Cálcio/uso terapêutico , Humanos , Pregabalina/uso terapêutico
8.
Internist (Berl) ; 61(3): 254-260, 2020 Mar.
Artigo em Alemão | MEDLINE | ID: mdl-32030437

RESUMO

The peripheral nervous system is subject to changes during the aging process, e.g., deep tendon reflexes decrease, as proprioception does. In contrast, polyneuropathies have to be distinguished from age-associated changes as independent diseases with etiologies similar to those in younger ages. Incidence of polyneuropathies is reported about 118/100,000, the overall prevalence in the general population is estimated to be about 1% and rises to up to 7% in the elderly. Etiology includes metabolic disorders, primary inflammatory polyneuropathies, systemic disorders and vasculitic neuropathies. Due to the age-specific increase of the prevalence of certain etiologies, neuropathies associated with diabetes, malignancy, and monoclonal gammopathies are even more common in older patients. However, the proportion of cryptogenic neuropathies, e.g. neuropathies without obvious cause, increases also with age. In older age, polyneuropathies additionally impair mobility and increase the risk of falling, thus the assessment of functional abilities is mandatory. It is essential to try to identify the underlying cause by a systematic approach including history, clinical investigation, neurophysiological and lab exams. Treatment of polyneuropathies is based on therapy of underlying conditions and requires management of neuropathic pain in the majority of cases. Physiotherapy and rehabilitation target pain relief and sustaining activities of daily living.


Assuntos
Envelhecimento , Nefropatias Diabéticas , Gamopatia Monoclonal de Significância Indeterminada , Paraproteinemias , Polineuropatias/etiologia , Atividades Cotidianas , Idoso , Humanos , Neuralgia , Manejo da Dor
9.
Medicine (Baltimore) ; 99(8): e19325, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32080151

RESUMO

Elucidation of epigenetic mechanisms correlating with neuropathic pain in humans is crucial for the prevention and treatment of this treatment-resistant pain state. In the present study, associations between neuropathic pain characteristics and DNA methylation of the transient receptor potential ankyrin 1 (TRPA1) gene were evaluated in chronic pain patients and preoperative patients. Pain and psychological states were prospectively assessed in patients who suffered chronic pain or were scheduled for thoracic surgery. Neuropathic characteristics were assessed using the Douleur Neuropathique 4 (DN4) questionnaire. DNA methylation levels of the CpG islands in the TRPA1 gene were examined using whole blood. Forty-eight adult patients were enrolled in this study. Increases in DNA methylation rates at CpG -51 showed positive correlations with increases in the DN4 score both in preoperative and chronic pain patients. Combined methylation rates at CpG -51 in these patients also significantly increased together with increase in DN4 scores. Neuropathic pain characteristics are likely associated with methylation rates at the promoter region of the TRPA1 gene in human peripheral blood.


Assuntos
Metilação de DNA , Neuralgia/genética , Canal de Cátion TRPA1/genética , Idoso , Dor Crônica/genética , Ilhas de CpG , Depressão/psicologia , Feminino , Humanos , Masculino , Neuralgia/psicologia , Medição da Dor , Regiões Promotoras Genéticas , Estudos Prospectivos
10.
Internist (Berl) ; 61(3): 243-253, 2020 Mar.
Artigo em Alemão | MEDLINE | ID: mdl-32086529

RESUMO

Approximately one of three people with diabetes is affected by distal symmetric sensorimotor polyneuropathy (DSPN) which is associated with marked impairment in quality of life due to partly excruciating neuropathic pain on the one hand and painless foot ulcers on the other hand. The prevalence of painful DSPN may reach up to one quarter of patients with diabetes, while DSPN may be asymptomatic in up to half of the patients affected. Regrettably, DSPN still remains underdiagnosed. Typical neuropathic symptoms include pain, paresthesias and numbness particularly in the feet and calves. The management of DSPN includes three cornerstones: (1) lifestyle modification, causal treatment aimed at near-normoglycemia and multifactorial cardiovascular risk intervention, (2) pathogenesis-derived treatment and (3) symptomatic treatment of neuropathic pain. Multimodal pain treatment should not only aim at pain relief, but also allow for improvement in quality of sleep, mobility, and general quality of life.


Assuntos
Complicações do Diabetes , Diabetes Mellitus , Neuropatias Diabéticas/terapia , Neuralgia , Polineuropatias/terapia , Qualidade de Vida , Animais , Bovinos , Neuropatias Diabéticas/psicologia , Humanos , Polineuropatias/psicologia , Prevalência
11.
Instr Course Lect ; 69: 509-522, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32017749

RESUMO

Numerous nerve disorders affect the foot and ankle, and specificity is essential for diagnosis. We review a systematic process to conduct a history and physical examination for nerve disorders and how to categorize these pathologies. Several common nerve-related pathologies of the foot and ankle are then described. Finally, we discuss systemic neurologic conditions which can cause symptoms in the foot and ankle. A vast array of treatment options exist for painful nerve lesions of the foot: both nonsurgical and surgical. Treatment options depend on the affected nerve's function and location within the foot. Essential nerves will be managed much differently than nonessential nerves. Also important to consider is whether this is the initial treatment, treatment following one recurrence, or treatment following multiple recurrences. After the proper diagnosis is made, consideration of these principles should allow for early and effective interventions to be made. Recalcitrant nerve conditions of the foot and ankle can represent a management challenge. As with primary nerve disorders, surgical management is warranted in cases where conservative management fails. Furthermore, patients may continue to experience neurologic complications or recurrence of symptoms even after surgical intervention, at which point further surgical procedures may be undertaken. Neurolysis, transection with or without containment, barrier procedures, and peripheral nerve stimulation are viable potential surgical options for patients with chronic or recurrent nerve pain, depending upon patient-specific underlying pathology.


Assuntos
Tornozelo , , Neuralgia/terapia , Articulação do Tornozelo , Humanos , Exame Físico
12.
Gene ; 736: 144386, 2020 Apr 30.
Artigo em Inglês | MEDLINE | ID: mdl-31978512

RESUMO

Neuropathic pain, caused by damage to the nerve system, is one of the most challenging diseases in the world. Moreover, the etiology remains unclear. Circular RNAs (circRNAs) have been revealed to participate in various biological progress, including neuropathic pain. However, the way circRNAs participate in the progress of neuropathic pain still needs further study. In this research, we established CCI rat models and measured the expression level of ciRS-7 in the spinal dorsal horn in the postoperative rats. The level of ciRS-7 was positively associated with the progress of neuropathic pain. Next, we test the expression of autophagy and inflammation in the CCI rats, and the results indicate that ciRS-7 associates with the progress of neuropathic pain partly by upregulated the expression level of autophagy and inflammation in the CCI rats. Furthermore, we found ciRS-7 regulates neuropathic pain progress by sponging to miR-135a-5p. In CCI rats, inhibiting miR-135a-5p decreases the level of autophagy and inflammation and alleviates neuropathic pain. We present this research that might provide a new insight for neuropathic pain study.


Assuntos
Autofagia/genética , Constrição Patológica/genética , Inflamação/genética , MicroRNAs/genética , Neuralgia/genética , RNA Longo não Codificante/genética , Animais , Linhagem Celular , Células HEK293 , Humanos , Masculino , Ratos , Ratos Sprague-Dawley , Transdução de Sinais/genética , Regulação para Cima/genética
13.
Plast Reconstr Surg ; 145(2): 368e-381e, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31985643

RESUMO

BACKGROUND: Acellular nerve allografts are a viable treatment modality for bridging nerve gaps. Several small studies have demonstrated results equal to those of autologous grafts; however, there is information lacking with regard to outcomes for wider indications. The authors evaluated the outcomes of patients treated with a nerve allograft in a variety of clinical situations. METHODS: A retrospective chart analysis was completed between April of 2009 and October of 2017. Inclusion criteria were age 18 years or older at the time of surgery and treatment with a nerve allograft. Patients were excluded if they had not been followed up for a minimum of 6 months. The modified Medical Research Council Classification was used to monitor motor and sensory changes in the postoperative period. RESULTS: Two hundred seven nerve allografts were used in 156 patients; of these, 129 patients with 171 nerve allografts fulfilled the inclusion criteria. Seventy-seven percent of patients achieved a sensory outcome score of S3 or above and 36 percent achieved a motor score of M3 or above. All patients with chronic pain had improvement of their symptoms. Graft length and diameter were negatively correlated with reported outcomes. One patient elected to undergo revision surgery, and the original graft was shown histologically to have extensive central necrosis. Anatomically, allografts used for lower limb reconstruction yielded the poorest results. All chronic patients had a significantly lower postoperative requirement for analgesia, and allografts were effective in not only reducing pain but also restoring a functional level of sensation. CONCLUSIONS: This study supports the wider application of allografts in managing nerve problems. However, caution must be applied to the use of long grafts with larger diameters. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.


Assuntos
Traumatismos dos Nervos Periféricos/cirurgia , Nervos Periféricos/transplante , Procedimentos Cirúrgicos Reconstrutivos/métodos , Adulto , Idoso , Aloenxertos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Regeneração Nervosa/fisiologia , Neuralgia/cirurgia , Estudos Retrospectivos , Adulto Jovem
14.
Eur J Med Chem ; 188: 111920, 2020 Feb 15.
Artigo em Inglês | MEDLINE | ID: mdl-31901745

RESUMO

γ-Aminobutyric acid (GABA) uptake transporters are membrane transport proteins that are involved in the pathophysiology of a number of neurological disorders. Some types of chronic pain appear to result from the dysfunction of the GABAergic system. The deficiency of mouse GAT1 transporter (mGAT1) abolishes the nociceptive response, which means that mGAT1 inhibition is an appropriate medical approach to achieve analgesia. The mGAT4 transporter is the second most abundant GAT subtype in the brain; however, its physiological role has not yet been fully understood in the central nervous system. In this study, we examined whether the combination of mGAT1 and mGAT3/mGAT4 inhibition in a single molecule might lead to potentially synergistic effects improving analgesic activity to relieve neuropathic pain. To study this hypothesis, new GABA uptake inhibitors were designed, synthesized, and evaluated in terms of their activity and subtype selectivity for mGAT1-4. Among new functionalized amino acid derivatives of serine and GABA analogs, compounds with preferential mGAT3/4 inhibitory activity were discovered. Two selected hits (19b and 31c) were subjected to in vivo tests. We found a statistically significant antiallodynic activity in the von Frey test in diabetic and oxaliplatin-induced neuropathic pain model. The novel compounds (4-hydroxybutanoic, 4-hydroxypentanoic, and 4-aminobutanoic acid derivatives and serine analogs) provide new insights into the structure-activity relationship of mGAT3/mGAT4 inhibitors and indicate a new direction in the search for potential treatment of neuropathic pain of various origin.


Assuntos
Analgésicos/uso terapêutico , Proteínas da Membrana Plasmática de Transporte de GABA/metabolismo , Inibidores da Captação de GABA/uso terapêutico , Hiperalgesia/tratamento farmacológico , Neuralgia/tratamento farmacológico , Limiar da Dor/efeitos dos fármacos , Analgésicos/síntese química , Analgésicos/metabolismo , Animais , Diabetes Mellitus Experimental/induzido quimicamente , Diabetes Mellitus Experimental/complicações , Proteínas da Membrana Plasmática de Transporte de GABA/química , Inibidores da Captação de GABA/síntese química , Inibidores da Captação de GABA/metabolismo , Hiperalgesia/induzido quimicamente , Hiperalgesia/etiologia , Masculino , Camundongos , Simulação de Acoplamento Molecular , Estrutura Molecular , Neuralgia/induzido quimicamente , Neuralgia/etiologia , Oxaliplatina , Ligação Proteica , Estreptozocina , Relação Estrutura-Atividade
15.
Postgrad Med ; 132(1): 28-36, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31900074

RESUMO

Interest in and use of topical analgesics has been increasing, presumably due to their potential utility for relief of acute and chronic pain. Topically applied agents with analgesic properties can target peripheral nociceptive pathways while minimizing absorption into the plasma that leads to potential systemic adverse effects.Clinical trials have found 5% lidocaine patches to be effective and well tolerated for the treatment of post-herpetic neuralgia (PHN) with a minimal risk of toxicity or drug-drug interactions. With this patch formulation, the penetration of lidocaine into the skin produces an analgesic effect without producing a complete sensory block. Use of topical lidocaine is supported by clinical practice guidelines, including first-line treatment by the American Academy of Neurology (guidelines retired 2018), the European Federation of Neurological Societies and second-line by the Canadian Pain Society.FDA approved 5% lidocaine patches in 1999, and a 1.8% topical lidocaine system in 2018 - both indicated for the treatment of pain secondary to PHN. The 1.8% system offers a more efficient delivery of lidocaine that is bioequivalent to 5% lidocaine patches, but with a 19-fold decrease in drug load (i.e., 36 mg versus 700 mg) as well as superior adhesion that allows the patch to maintain contact with the skin during the 12-h administration period.Although topical lidocaine formulations have advanced over time and play an important role in the treatment of PHN, a variety of other conditions that respond to topical lidocaine have been reported in the literature including PHN, lower back pain, carpal tunnel syndrome, diabetic peripheral neuropathy, and osteoarthritis joint pain. Other neuropathic or nociceptive pain syndromes may respond to topical lidocaine in select cases and warrant further study. Clinicians should consider local anesthetics and other topical agents as part of their multimodal treatments of acute and chronic pain.


Assuntos
Analgésicos/administração & dosagem , Lidocaína/administração & dosagem , Administração Cutânea , Analgésicos/uso terapêutico , Humanos , Lidocaína/uso terapêutico , Neuralgia/tratamento farmacológico , Adesivo Transdérmico
16.
Eur J Med Chem ; 186: 111902, 2020 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-31771828

RESUMO

We recently identified novel small-molecule antagonists of the PACAP type I (PAC1) receptor using docking-based in silico screening followed by in vitro/vivo pharmacological assays. In the present study, we synthesized 18 novel derivatives based on the structure of PA-9, a recently developed antagonist of the PAC1 receptor, with a view to obtain a panel of compounds with more potent antagonistic and analgesic activities. Among them, compound 3d showed improved antagonistic activities. Intrathecal injection of 3d inhibited both pituitary adenylate cyclase-activating polypeptide (PACAP) and spinal nerve ligation-induced mechanical allodynia. The effects were more potent than PA-9. Compound 3d also showed anti-allodynic effects following oral administration. Hence, our results suggest that 3d may become an orally available analgesic in the treatment of the neuropathic pain.


Assuntos
Analgésicos/farmacologia , Neuralgia/tratamento farmacológico , Receptores de Polipeptídeo Hipofisário Ativador de Adenilato Ciclase/antagonistas & inibidores , Bibliotecas de Moléculas Pequenas/farmacologia , Analgésicos/síntese química , Analgésicos/química , Animais , Comportamento Animal/efeitos dos fármacos , Relação Dose-Resposta a Droga , Masculino , Camundongos , Camundongos Endogâmicos , Estrutura Molecular , Neuralgia/metabolismo , Receptores de Polipeptídeo Hipofisário Ativador de Adenilato Ciclase/metabolismo , Bibliotecas de Moléculas Pequenas/síntese química , Bibliotecas de Moléculas Pequenas/química , Relação Estrutura-Atividade
17.
World Neurosurg ; 133: 167-171, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31606507

RESUMO

BACKGROUND: Short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) is a primary headache syndrome with an unclear pathogenesis, and only in very few cases, SUNCT is secondary to known lesions (secondary SUNCT). Several pharmacological as well as interventional and invasive treatments have been used to treat SUNT cases, with no definitive results. We describe a patient with idiopathic SUNCT syndrome, successfully treated with gamma knife radiosurgery and we report a review of the cases of the literature treated with radiosurgery. CASE REPORT: A 63-year-old woman complained of episodes of intense and regular paroxysmal facial pain in the territory of the maxillary branch of the trigeminal nerve accompanied by inflammation of conjunctiva and involuntary lacrimation from 2006. During the following years, she received several treatments: combination of drugs, acupuncture, and endonasal infiltration of the sphenopalatine ganglion. The frequency of the painful attacks increased progressively and it was impossible for her to have a normal active life. Combined gamma knife radiosurgery treatment, targeting the trigeminal nerve (80 Gy maximum dose) and the sphenopalatine ganglion (80 Gy maximum dose) was performed in April 2016 (visual analog score before treatment = 6). Pain gradually reduced in the following months, as well as frequency and severity of the attacks. No sensory deficit developed. The follow-up length of our patient is 37 months: she is nearly pain free (visual analog score = 2) and has resumed a normal life. CONCLUSIONS: Patients with idiopathic SUNCT have few therapeutic options. Our case demonstrates that gamma knife radiosurgery is a feasible and effective noninvasive option to treat patients with medically refractory idiopathic SUNCT.


Assuntos
Cefaleia/radioterapia , Neuralgia/radioterapia , Radiocirurgia , Síndrome SUNCT/diagnóstico por imagem , Síndrome SUNCT/radioterapia , Feminino , Cefaleia/diagnóstico por imagem , Humanos , Imagem por Ressonância Magnética , Pessoa de Meia-Idade , Neuralgia/diagnóstico por imagem , Resultado do Tratamento , Nervo Trigêmeo
18.
Schmerz ; 34(1): 21-32, 2020 Feb.
Artigo em Alemão | MEDLINE | ID: mdl-31562537

RESUMO

BACKGROUND: Neuropathic pain consistently presents a significant therapeutic challenge. Topically applied analgesics have the advantage of showing low systemic side effects, but data on long-term effectiveness are lacking. Consequently, interviews were carried out with all patients being treated with topical analgesics in hospital. METHODS: Ethics 16-5690, German Clinical Trials Register (DRKS) 00011877. Between 2008 and 2017 a total of 265 patients were treated at least once with either capsaicin 8% (C), lidocaine 5% (L) and/or perineural botulinum toxin type A (B). From this sample, 205 patients (77%) were interviewed by telephone for feedback on pain reduction (first/last treatment: low/moderate/very good), the possible reduction of analgesic prescription and if applicable the reasons for discontinuation of use (time of interview C: 26 ± 19 months, L: 61 ± 23 months, B: 11 ± 6 months after start). Further pretreatment data and diagnoses were obtained from the in-house documentation system. Responders or long-term responders were defined as patients with at least one moderate pain reduction after the first or last treatment, as long as the effect was adequately maintained. RESULTS: In all treatment groups (56 ± 13 years, 62% male, C: 80, L: 84, B: 58 patients) patients with a long history of pain (C: 60 ± 73 months, L: 59 ± 66 months, B: 67 ± 71 months) and high pain intensity (numeric rating scale, NRS, C: 7 ± 2, L: 7 ± 2, B: 6 ± 2), were predominant. The highest primary and long-term responder rates were exhibited by L (57%/60%, B: 52%/37%, C: 23%/15%). With B, long-term responders were most frequently able to reduce analgesic use (74%, C: 58%, L: 38%). DISCUSSION: Despite the long duration of the disease, the most used off-label topical drugs L and B demonstrated a high primary response rate (in contrast to C), with most benefiting from long-term treatment.


Assuntos
Analgésicos , Toxinas Botulínicas Tipo A , Neuralgia , Administração Tópica , Analgésicos/administração & dosagem , Capsaicina , Feminino , Humanos , Lidocaína , Masculino , Neuralgia/tratamento farmacológico
19.
J Oral Facial Pain Headache ; 34(1): 13­30, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31339967

RESUMO

AIMS: To evaluate the efficacy of low-level laser therapy (LLLT) for the therapeutic management of neuropathic orofacial pain. METHODS: This systematic review was conducted according to PRISMA guidelines. A comprehensive search of the literature was conducted in the PubMed/MEDLINE, Scopus, and Cochrane Library databases up to March 8, 2018, using terms such as low-level laser therapy, neuropathic pain, orofacial pain, neuralgia, neuropathy, and all the entities described in section 13 of the International Classification of Headache Disorders, third edition. The primary outcome was measurement of pain intensity. RESULTS: A total of 997 studies were obtained with the initial search; 13 (8 randomized controlled trials, 2 prospective studies, and 3 case series) met the inclusion criteria and were analyzed for data extraction. Three provided data for the treatment of trigeminal neuralgia, 1 for occipital neuralgia, and 10 for burning mouth syndrome. All studies showed a reduction in pain intensity (most of them significant). The different studies analyzed LLLT alone and compared to placebo, to another treatment, or to different LLLT application protocols. CONCLUSION: LLLT seems to be effective as a treatment option for different neuropathic orofacial pain entities such as trigeminal neuralgia, occipital neuralgia, and burning mouth syndrome as a single or combined treatment. However, more quality studies assessing all outcome measures of chronic pain are needed in the medium and long terms. Furthermore, due to the lack of standardization of the application technique, more well-designed studies are required to confirm the results of this systematic review.


Assuntos
Dor Crônica , Terapia com Luz de Baixa Intensidade , Neuralgia , Dor Facial , Humanos , Estudos Prospectivos
20.
Support Care Cancer ; 28(1): 279-285, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31041583

RESUMO

PURPOSE: Tumor-related cancer pain often comprises mixed pain with both nociceptive and neuropathic components. Whether tumor-related cancer pain includes a neuropathic component impacts the therapeutic strategy. The aim of this cross-sectional study was to investigate the usefulness of two screening tools for neuropathic pain, painDETECT and Self-Report Leeds Assessment of Neuropathic Symptoms and Signs (S-LANSS), in identifying the neuropathic component of mixed pain among patients with tumor-related cancer pain. METHOD: This cross-sectional study recruited consecutive inpatients and outpatients at a single site. The diagnostic accuracy of painDETECT and S-LANSS was evaluated using receiver operating characteristic curve analysis and classification probability. RESULTS: Of the study group, 106 patients had tumor-related cancer pain. Analyses of the nociceptive and mixed pain groups (n = 104) showed that neither painDETECT nor S-LANSS had satisfactory areas under the curve (AUCs) for identifying the neuropathic component of mixed pain (0.59 for painDETECT and 0.56 for S-LANSS). By pain intensity, the AUC for painDETECT was significantly higher in the mild pain group than in the moderate or severe pain group (0.77 vs. 0.43, P = 0.002). All parameters of classification probability for both tools were higher in the mild pain group than in the moderate or severe pain group. CONCLUSIONS: painDETECT and S-LANSS could not identify the neuropathic component of mixed pain among patients with tumor-related cancer pain, especially when pain was moderate or severe. Contrarily, these screening tools might be useful for identifying the neuropathic component of mixed pain for mild pain.


Assuntos
Dor do Câncer/diagnóstico , Programas de Rastreamento/métodos , Neuralgia/diagnóstico , Medição da Dor/métodos , Autorrelato , Idoso , Dor do Câncer/epidemiologia , Comorbidade , Estudos Transversais , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/complicações , Neoplasias/diagnóstico , Neoplasias/epidemiologia , Neuralgia/epidemiologia , Neuralgia/etiologia , Valor Preditivo dos Testes , Autoavaliação , Inquéritos e Questionários
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