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2.
Artigo em Russo | MEDLINE | ID: mdl-38884429

RESUMO

OBJECTIVE: To identify the characteristics of pain syndrome in patients with schwannomas depending on genetic predisposition. MATERIAL AND METHODS: The study included 46 patients with peripheral, spinal and intracranial schwannomas, corresponding to the schwannomatosis phenotype according to the 2022 clinical criteria. All patients underwent sequencing of the LZRT1, Nf2 and SMARCB1 and a copy number study in the NF2. RESULTS: The most severe widespread pain was observed in patients with pathogenic LZRT1 variants, while patients with mosaic variants may not even have local tumor-related pain. Patients with SMARCB1variants may have no pain or have localized pain that responds well to surgical treatment. CONCLUSION: Further studies of the molecular features of schwannomatosis and driver mutations in the pathogenesis of pain are necessary to improve the effectiveness of pain therapy in this group of patients. Schwannomatosis is a disease from the group of neurofibromatosis, manifested by the development of multiple schwannomas. Neuropathic pain is one of the main symptoms characteristic of peripheral schwannomas, however, the severity and prevalence of the pain syndrome does not always correlate with the location of the tumors. According to modern concepts, the key factors influencing the characteristics of the pain syndrome are the target gene and the type of pathogenic variant. The most severe widespread pain is observed in patients with pathogenic variants in the LZRT1 gene, while patients with mosaic variants may not even have local pain associated with tumors. Patients with variants in SMARCB1 may have no pain or localized pain that responds well to surgical treatment.


Assuntos
Neurilemoma , Neurofibromatoses , Proteína SMARCB1 , Humanos , Neurilemoma/genética , Neurilemoma/complicações , Neurilemoma/diagnóstico , Neurofibromatoses/complicações , Neurofibromatoses/genética , Masculino , Feminino , Adulto , Proteína SMARCB1/genética , Pessoa de Meia-Idade , Neoplasias Cutâneas/genética , Neoplasias Cutâneas/complicações , Neurofibromina 2/genética , Fatores de Transcrição/genética , Mutação , Neuralgia/genética , Neuralgia/etiologia , Neuralgia/diagnóstico , Predisposição Genética para Doença , Adulto Jovem
3.
Methods Cell Biol ; 188: 73-88, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38880529

RESUMO

Neuropathic pain, defined as the most terrible of all tortures, which a nerve wound may inflict, is a common chronic painful condition caused by gradual damage or dysfunction of the somatosensory nervous system. As with many chronic diseases, neuropathic pain has a profound economic and emotional impact worldwide and represents a major public health issue from a treatment standpoint. This condition involves multiple sensory symptoms including impaired transmission and perception of noxious stimuli, burning, shooting, spontaneous pain, mechanical or thermal allodynia and hyperalgesia. Current pharmacological options for the treatment of neuropathic pain are limited, ineffective and have unacceptable side effects. In this framework, a deeper understanding of the pathophysiology and molecular mechanisms associated with neuropathic pain is key to the development of promising new therapeutical approaches. For this purpose, a plethora of experimental models that mimic common clinical features of human neuropathic pain have been characterized in rodents, with the spinal nerve ligation (SNL) model being one of the most widely used. In this chapter, we provide a detailed surgical procedure of the SNL model used to induce neuropathic pain in rats and mice. We further describe the behavioral approaches used for stimulus-evoked and spontaneous pain assessment in rodents. Finally, we demonstrate that our SNL model induces multiple pain behaviors in rats and mice.


Assuntos
Modelos Animais de Doenças , Neuralgia , Nervos Espinhais , Animais , Neuralgia/patologia , Neuralgia/fisiopatologia , Neuralgia/etiologia , Ligadura/métodos , Ligadura/efeitos adversos , Ratos , Camundongos , Hiperalgesia/fisiopatologia , Medição da Dor/métodos , Masculino
4.
CNS Neurosci Ther ; 30(6): e14813, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38887838

RESUMO

BACKGROUND: Central poststroke pain (CPSP) is one of the primary sequelae following stroke, yet its underlying mechanisms are poorly understood. METHODS: By lesioning the lateral thalamic nuclei, we first established a CPSP model that exhibits mechanical and thermal hypersensitivity. Innocuous mechanical stimuli following the thalamic lesion evoked robust neural activation in somatosensory corticospinal neurons (CSNs), as well as in the deep dorsal horn, where low threshold mechanosensory afferents terminate. In this study, we used viral-based mapping and intersectional functional manipulations to decipher the role of somatosensory CSNs and their spinal targets in the CPSP pathophysiology. RESULTS: We first mapped the post-synaptic spinal targets of lumbar innervating CSNs using an anterograde trans-synaptic AAV1-based strategy and showed these spinal interneurons were activated by innocuous tactile stimuli post-thalamic lesion. Functionally, tetanus toxin-based chronic inactivation of spinal neurons targeted by CSNs prevented the development of CPSP. Consistently, transient chemogenetic silencing of these neurons alleviated established mechanical pain hypersensitivity and innocuous tactile stimuli evoked aversion linked to the CPSP. In contrast, chemogenetic activation of these neurons was insufficient to induce robust mechanical allodynia typically observed in the CPSP. CONCLUSION: The CSNs and their spinal targets are required but insufficient for the establishment of CPSP hypersensitivity. Our study provided novel insights into the neural mechanisms underlying CPSP and potential therapeutic interventions to treat refractory central neuropathic pain conditions.


Assuntos
Neuralgia , Tratos Piramidais , Acidente Vascular Cerebral , Animais , Neuralgia/etiologia , Neuralgia/fisiopatologia , Masculino , Acidente Vascular Cerebral/complicações , Neurônios , Hiperalgesia/fisiopatologia , Hiperalgesia/etiologia , Ratos Sprague-Dawley , Ratos , Modelos Animais de Doenças , Medula Espinal
5.
Pain Physician ; 27(4): 253-262, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38805532

RESUMO

BACKGROUND: In our clinical practice, we observed that some osteoporotic vertebral compression fracture patients undergoing vertebral augmentation exhibited pain in the iliac crest region. This pain aligned with the diagnostic criteria for superior cluneal neuralgia (SCN) and affected treatment satisfaction. OBJECTIVE: This study aims to clinically observe patients undergoing vertebral augmentation in a hospital setting and analyze the etiology and risk factors associated with SCN. STUDY DESIGN: Retrospective cohort study. SETTING: Inpatient population of a single center. METHODS: We retrospectively analyzed clinical data from 630 patients who underwent vertebral augmentation in our hospital from March 2022 to March 2023. Fifty-two patients enrolled in the study experienced pain that met the diagnostic criteria for superior cluneal neuralgia during the perioperative period of the vertebral augmentation procedures. Those patients were divided into 2 subgroups according to the conditions involved in the occurrence of SCN: Group A (26 patients) had either no preoperative SCN but developed it postoperatively, or had preoperative SCN that worsened or did not alleviate postoperatively. Group B (26 patients) had preoperative SCN that was relieved postoperatively. Additionally, 52 consecutive patients in March 2022 to March 2023. who did not experience SCN during the perioperative period were selected as the control group (Group C). Variables such as surgical segment, age, height, weight, body mass index, duration of hospitalization, chronic low back pain (CLBP), duration of pain, anesthesia, surgical approach, fracture pattern, preoperative visual analog scale (pre-op VAS) score, intraoperative VAS score, one-day VAS score, one-month VAS score, lumbar sacral angle, and sacral tilt angle were statistically described and analyzed. RESULTS: In our hospital, the incidence of SCN during the perioperative period of vertebral augmentation procedures is 8.25% (52/630). Among all the segments of patients who developed SCN during the perioperative period, the L1 segment had the highest proportion, which was 29.03% and 35.14% in Groups A and B, respectively. Group B and Group C showed significant differences in duration of hospitalization (P = 0.012), pre-op VAS scores (P = 0.026), and CLBP (P < 0.001). Group A had significantly higher VAS scores preoperatively (P = 0.026) and intraoperatively (P = 0.004) and in CLBP (P = 0.001) than did Group C. LIMITATIONS: This is a retrospective study. Single-center noncontrolled studies may introduce selection bias. The small sample size in each group might have also led to bias. CONCLUSION: Perioperative SCN associated with vertebral augmentation is significantly correlated with preoperative VAS scores and CLBP. In addition, intraoperative VAS scores might be a factor contributing to the nonalleviation or exacerbation of postoperative SCN.


Assuntos
Fraturas da Coluna Vertebral , Humanos , Estudos Retrospectivos , Masculino , Feminino , Idoso , Fraturas da Coluna Vertebral/cirurgia , Pessoa de Meia-Idade , Neuralgia/etiologia , Neuralgia/cirurgia , Fraturas por Compressão/cirurgia , Fraturas por Osteoporose/cirurgia , Vertebroplastia/métodos
6.
Int J Med Sci ; 21(7): 1265-1273, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38818478

RESUMO

This study investigated the effects of pregabalin on microglial differentiation in rats with neuropathic pain (NP) induced by sciatic nerve ligation and transection. After confirming NP, the rats were randomly allocated to either a pregabalin or control group. The pregabalin group received intraperitoneal injections of 10 mg/kg pregabalin, while the control group received an equivalent volume of normal saline following surgery. On postoperative day 28, neuronal damage, microglial activity, and microglial differentiation were assessed. The pregabalin group exhibited significantly less neuronal damage compared to the control group, along with a significant decrease in activated microglial expression in both the brain and spinal cord. Pregabalin treatment also significantly altered the microglial phenotype expression, with a decrease in the M1 phenotype percentage and an increase in the M2 phenotype percentage in both the brain (M1 phenotype: 43.52 ± 12.16% and 18.00 ± 8.57% in the control and pregabalin groups, respectively; difference: 27.26 [15.18-42.10], p = 0.002; M2 phenotype: 16.88 ± 6.47% and 39.63 ± 5.82% in the control and pregabalin groups, respectively; difference 22.04 [17.17-32.70], p < 0.001) and the spinal cord ipsilateral to nerve injury (M1 phenotype: 44.35 ± 12.12% and 13.78 ± 5.39% in the control and pregabalin groups, respectively; difference 30.46 [21.73-44.45], p < 0.001; M2 phenotype: 7.64 ± 3.91% and 33.66 ± 7.95% in the control and pregabalin groups, respectively; difference 27.41 [21.21-36.30], p < 0.001). Overall, pregabalin treatment significantly decreased the microglial M1 phenotype while increasing the microglial M2 phenotype in NP rats.


Assuntos
Diferenciação Celular , Microglia , Neuralgia , Pregabalina , Animais , Pregabalina/farmacologia , Pregabalina/uso terapêutico , Microglia/efeitos dos fármacos , Microglia/patologia , Neuralgia/tratamento farmacológico , Neuralgia/patologia , Neuralgia/etiologia , Ratos , Diferenciação Celular/efeitos dos fármacos , Masculino , Medula Espinal/efeitos dos fármacos , Medula Espinal/patologia , Modelos Animais de Doenças , Analgésicos/farmacologia , Analgésicos/uso terapêutico , Nervo Isquiático/efeitos dos fármacos , Nervo Isquiático/patologia , Ratos Sprague-Dawley , Humanos , Encéfalo/efeitos dos fármacos , Encéfalo/patologia
7.
Bone Joint J ; 106-B(6): 582-588, 2024 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-38821515

RESUMO

Aims: The aim of this study was to describe the prevalence and patterns of neuropathic pain over one year in a cohort of patients with chronic post-surgical pain at three months following total knee arthroplasty (TKA). Methods: Between 2016 and 2019, 363 patients with troublesome pain, defined as a score of ≤ 14 on the Oxford Knee Score pain subscale, three months after TKA from eight UK NHS hospitals, were recruited into the Support and Treatment After Replacement (STAR) clinical trial. Self-reported neuropathic pain and postoperative pain was assessed at three, nine, and 15 months after surgery using the painDETECT and Douleur Neuropathique 4 (DN4) questionnaires collected by postal survey. Results: Symptoms of neuropathic pain were common among patients reporting chronic pain at three months post-TKA, with half reporting neuropathic pain on painDETECT (191/363; 53%) and 74% (267/359) on DN4. Of those with neuropathic pain at three months, half continued to have symptoms over the next 12 months (148/262; 56%), one-quarter had improved (67/262; 26%), and for one-tenth their neuropathic symptoms fluctuated over time (24/262; 9%). However, a subgroup of participants reported new, late onset neuropathic symptoms (23/262; 9%). Prevalence of neuropathic symptoms was similar between the screening tools when the lower cut-off painDETECT score (≥ 13) was applied. Overall, mean neuropathic pain scores improved between three and 15 months after TKA. Conclusion: Neuropathic pain is common in patients with chronic pain at three months after TKA. Although neuropathic symptoms improved over time, up to half continued to report painful neuropathic symptoms at 15 months after TKA. Postoperative care should include screening, assessment, and treatment of neuropathic pain in patients with early chronic postoperative pain after TKA.


Assuntos
Artroplastia do Joelho , Dor Crônica , Neuralgia , Dor Pós-Operatória , Humanos , Artroplastia do Joelho/efeitos adversos , Neuralgia/etiologia , Neuralgia/epidemiologia , Dor Pós-Operatória/etiologia , Dor Pós-Operatória/epidemiologia , Feminino , Masculino , Prevalência , Idoso , Pessoa de Meia-Idade , Dor Crônica/epidemiologia , Dor Crônica/etiologia , Medição da Dor , Reino Unido/epidemiologia , Inquéritos e Questionários
8.
Exp Mol Med ; 56(5): 1193-1205, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38760512

RESUMO

Neuropathic pain is a debilitating condition caused by the hyperexcitability of spinal dorsal horn neurons and is often characterized by allodynia. Although neuron-independent mechanisms of hyperexcitability have been investigated, the contribution of astrocyte-neuron interactions remains unclear. Here, we show evidence of reactive astrocytes and their excessive GABA release in the spinal dorsal horn, which paradoxically leads to the tonic excitation of neighboring neurons in a neuropathic pain model. Using multiple electrophysiological methods, we demonstrated that neuronal hyperexcitability is attributed to both increased astrocytic GABA synthesis via monoamine oxidase B (MAOB) and the depolarized reversal potential of GABA-mediated currents (EGABA) via the downregulation of the neuronal K+/Cl- cotransporter KCC2. Furthermore, longitudinal 2-deoxy-2-[18F]-fluoro-D-glucose microPET imaging demonstrated increased regional glucose metabolism in the ipsilateral dorsal horn, reflecting neuronal hyperexcitability. Importantly, inhibiting MAOB restored the entire astrocytic GABA-mediated cascade and abrogated the increased glucose metabolism and mechanical allodynia. Overall, astrocytic GABA-mediated tonic excitation is critical for neuronal hyperexcitability, leading to mechanical allodynia and neuropathic pain.


Assuntos
Astrócitos , Glucose , Neuralgia , Ácido gama-Aminobutírico , Astrócitos/metabolismo , Animais , Neuralgia/metabolismo , Neuralgia/etiologia , Glucose/metabolismo , Ácido gama-Aminobutírico/metabolismo , Masculino , Camundongos , Neurônios/metabolismo , Hiperalgesia/metabolismo , Hiperalgesia/etiologia , Células do Corno Posterior/metabolismo , Monoaminoxidase/metabolismo , Modelos Animais de Doenças , Ratos , Cotransportadores de K e Cl-
9.
Curr Opin Rheumatol ; 36(4): 282-288, 2024 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-38690783

RESUMO

PURPOSE OF REVIEW: Pain is the most common and often most troublesome feature of chronic autoimmune diseases such as psoriatic arthritis (PsA) and axial spondyloarthritis (AxSpA). A predominant concept is that the main source of pain is from disease-induced tissue inflammation and structural damage, activating peripheral nerve fibers which relay to the central nervous system. This mechanism is nociceptive pain and the presumption has been that controlling inflammation will be sufficient to reduce this form of pain. However, despite control of inflammation, patients may still have significant residual pain. RECENT FINDINGS: We are learning that there are additional pain mechanisms, neuropathic and nociplastic, that are often operative in patients with rheumatologic conditions, that can significantly influence pain experience, quantitation of disease activity, and may benefit from therapeutic approaches distinct from immunotherapy. Neuropathic pain arises from diseased or damaged nerve tissue and nociplastic pain reflects sensitization of the central nervous system due to multiple genetic, neurobiologic, neural network dysregulation, and psychosocial factors. Pain arising from these mechanisms influence assessment of disease activity and thus needs to be factored into decision-making about immunotherapy efficacy. SUMMARY: This review addresses the importance of accurately assessing the complex mechanisms of pain experience in patients with PsA and AxSpA to more appropriately manage immunomodulatory, neuromodulatory, and nonpharmacologic therapies.


Assuntos
Artrite Psoriásica , Espondiloartrite Axial , Humanos , Artrite Psoriásica/complicações , Artrite Psoriásica/fisiopatologia , Artrite Psoriásica/psicologia , Espondiloartrite Axial/diagnóstico , Espondiloartrite Axial/complicações , Espondiloartrite Axial/etiologia , Espondiloartrite Axial/fisiopatologia , Manejo da Dor/métodos , Neuralgia/etiologia , Neuralgia/fisiopatologia
10.
Support Care Cancer ; 32(6): 383, 2024 May 27.
Artigo em Inglês | MEDLINE | ID: mdl-38801531

RESUMO

PURPOSE: The primary aim of this cross-sectional study is to examine the prevalence of pain phenotypes in breast cancer survivors (BCS). A secondary aim entails examining whether health related quality of life differs between the main pain phenotypes in BCS. METHODS: BCS who experienced chronic pain were asked to complete the numeric pain rating scale for pain, Margolis pain diagram, and short form 36 (SF-36). Following administration of questionnaires and quantitative sensory examinations were applied. To determine the prevalence of the predominant type of pain, a recently proposed classification system by the Cancer Pain Phenotyping (CANPPHE) Network was used. RESULTS: Of the 86 female participants, 19 (22.09%) had dominant neuropathic pain, 18 (20.93%) had dominant nociceptive pain and 14 (16.28%) had dominant nociplastic pain. 35 participants (40.70%) were classified as having mixed pain. One-way ANOVA revealed a significant difference between the four pain groups for the SF-36 general health (F = 3.205, p = 0.027), social functioning (F = 4.093, p = 0.009), and pain (F = 3.603, p = 0.017) subscale scores. CONCLUSION: This study found that pain in BCS was mostly of mixed phenotype, followed by predominantly neuropathic and nociplastic pain. Furthermore, it was found that, compared to BCS with predominant neuropathic and nociceptive pain, BCS with predominant nociplastic pain have lower health related quality of life in the areas of bodily pain and social functioning.


Assuntos
Neoplasias da Mama , Dor do Câncer , Sobreviventes de Câncer , Dor Crônica , Medição da Dor , Fenótipo , Qualidade de Vida , Humanos , Feminino , Estudos Transversais , Pessoa de Meia-Idade , Neoplasias da Mama/complicações , Sobreviventes de Câncer/estatística & dados numéricos , Dor Crônica/etiologia , Adulto , Medição da Dor/métodos , Dor do Câncer/etiologia , Dor do Câncer/epidemiologia , Inquéritos e Questionários , Idoso , Prevalência , Neuralgia/etiologia , Neuralgia/epidemiologia , Guias de Prática Clínica como Assunto
11.
Brain Res ; 1838: 148976, 2024 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-38705557

RESUMO

Central poststroke pain (CPSP) is a type of central neuropathic pain whose mechanisms remain unknown. Recently, we showed that activated astrocytes and microglial cells are present in the spinal cord of CPSP model mice. Activated glial cells exacerbate cerebral ischemic pathology by increasing the expression of inflammatory factors. However, the involvement of spinal glial cells in CPSP remains unknown. We hypothesized that spinal glial cell-derived molecules cause hyperexcitability or promoted the development of CPSP. In this study, we identified glial cell-derived factors involved in the development of CPSP using a bilateral common carotid occlusion (BCAO)-induced CPSP mouse model. Male ddY mice were subjected to BCAO for 30 min. The von Frey test assessed mechanical hypersensitivity in the right hind paw of mice. BCAO mice showed hypersensitivity to mechanical stimuli and astrocyte activation in the spinal cord 3 days after treatment. DNA microarray analysis revealed a significant increase in lipocalin 2 (LCN2), is known as neutrophil gelatinase-associated lipocalin, in the superficial dorsal horns of BCAO-induced CPSP model mice. LCN2 colocalized with GFAP, an astrocyte marker. Spinal GFAP-positive cells in BCAO mice co-expressed signal transducer and activator of transcription 3 (STAT3). The increase in the fluorescence intensity of LCN2 and GFAP in BCAO mice was suppressed by intrathecal injection of AG490, an inhibitor of JAK2 and downstream STAT3 activation, or anti-LCN2 antibody. Our findings indicated that LCN2 in spinal astrocytes may be a key molecule and may be partly involved in the development of CPSP.


Assuntos
Astrócitos , Modelos Animais de Doenças , Lipocalina-2 , Medula Espinal , Acidente Vascular Cerebral , Animais , Masculino , Lipocalina-2/metabolismo , Camundongos , Medula Espinal/metabolismo , Acidente Vascular Cerebral/metabolismo , Acidente Vascular Cerebral/complicações , Astrócitos/metabolismo , Fator de Transcrição STAT3/metabolismo , Neuralgia/metabolismo , Neuralgia/etiologia , Janus Quinase 2/metabolismo , Tirfostinas/farmacologia , Proteína Glial Fibrilar Ácida/metabolismo
12.
Clin Plast Surg ; 51(3): 419-434, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38789151

RESUMO

Burn-related chronic neuropathic pain can contribute to a decreased quality of life. When medical and pharmacologic therapies prove ineffective, patients should undergo evaluation for surgical intervention, consisting of a detailed physical examination and elective diagnostic nerve block, to identify an anatomic cause of pain. Based on symptoms and physical examination findings, particularly Tinel's sign, treatments can vary, including a trial of laser therapies, fat grafting, or nerve surgeries (nerve decompression, neuroma excision, targeted muscle reinnervation, regenerative peripheral nerve interfaces, and vascularized denervated muscle targets). It is essential to counsel patients to establish appropriate expectations prior to treatment with a multidisciplinary team.


Assuntos
Queimaduras , Dor Crônica , Neuralgia , Humanos , Neuralgia/cirurgia , Neuralgia/etiologia , Queimaduras/complicações , Queimaduras/cirurgia , Dor Crônica/cirurgia , Dor Crônica/etiologia
13.
Med Sci Monit ; 30: e943808, 2024 May 16.
Artigo em Inglês | MEDLINE | ID: mdl-38751083

RESUMO

BACKGROUND Chronic kidney disease (CKD) is a growing global health concern. Chronic pain, as a common symptom of CKD, particularly among patients with end-stage renal disease (ESRD), is influenced by complications, dialysis procedures, and comorbidities. We aimed to evaluate chronic pain and probable neuropathic pain in 96 dialysis patients with ESRD using the Douleur Neuropathique 4 (DN4) questionnaire. MATERIAL AND METHODS A total of 96 patients from a single dialysis center were enrolled for the purpose of this study. ESRD was caused by diseases causing kidney damage, such as diabetes. The average duration of maintenance dialysis was 4.6±5.67 years. Comorbidities, functional and mental assessment, and pharmacological treatment data were collected using a questionnaire. The satisfaction with life scale was also used. Chronic pain was defined as lasting more than 3 months. The DN4 was used to determine the neuropathic component of pain. RESULTS Chronic pain was observed in 63.5% of the study participants, with 47.5% of them reporting the presence of neuropathic pain accompanied by a neuropathic component. Significantly more patients with chronic pain reported mood disorders and reduced life satisfaction, but there was no difference in their activities of daily living-assessed functional status or duration of dialysis. Patients experiencing chronic pain received non-steroidal anti-inflammatory drugs, paracetamol, and opioids. CONCLUSIONS Chronic pain, especially with a neuropathic component, is highly prevalent in patients with CKD, and its treatment remains ineffective. Undiagnosed components of pain can contribute to underdiagnosis and inadequate therapy. Further studies and staff education are needed to address this important issue.


Assuntos
Dor Crônica , Falência Renal Crônica , Neuralgia , Diálise Renal , Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Falência Renal Crônica/terapia , Falência Renal Crônica/complicações , Diálise Renal/efeitos adversos , Neuralgia/terapia , Neuralgia/epidemiologia , Neuralgia/etiologia , Dor Crônica/terapia , Prevalência , Idoso , Inquéritos e Questionários , Adulto , Qualidade de Vida , Manejo da Dor/métodos , Comorbidade
14.
Pain ; 165(6): 1336-1347, 2024 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-38739766

RESUMO

ABSTRACT: Evidence from previous studies supports the concept that spinal cord injury (SCI)-induced neuropathic pain (NP) has its neural roots in the peripheral nervous system. There is uncertainty about how and to which degree mechanoreceptors contribute. Sensorimotor activation-based interventions (eg, treadmill training) have been shown to reduce NP after experimental SCI, suggesting transmission of pain-alleviating signals through mechanoreceptors. The aim of the present study was to understand the contribution of mechanoreceptors with respect to mechanical allodynia in a moderate mouse contusion SCI model. After genetic ablation of tropomyosin receptor kinase B expressing mechanoreceptors before SCI, mechanical allodynia was reduced. The identical genetic ablation after SCI did not yield any change in pain behavior. Peptidergic nociceptor sprouting into lamina III/IV below injury level as a consequence of SCI was not altered by either mechanoreceptor ablation. However, skin-nerve preparations of contusion SCI mice 7 days after injury yielded hyperexcitability in nociceptors, not in mechanoreceptors, which makes a substantial direct contribution of mechanoreceptors to NP maintenance unlikely. Complementing animal data, quantitative sensory testing in human SCI subjects indicated reduced mechanical pain thresholds, whereas the mechanical detection threshold was not altered. Taken together, early mechanoreceptor ablation modulates pain behavior, most likely through indirect mechanisms. Hyperexcitable nociceptors seem to be the main drivers of SCI-induced NP. Future studies need to focus on injury-derived factors triggering early-onset nociceptor hyperexcitability, which could serve as targets for more effective therapeutic interventions.


Assuntos
Modelos Animais de Doenças , Hiperalgesia , Mecanorreceptores , Camundongos Endogâmicos C57BL , Traumatismos da Medula Espinal , Animais , Traumatismos da Medula Espinal/complicações , Traumatismos da Medula Espinal/metabolismo , Traumatismos da Medula Espinal/fisiopatologia , Camundongos , Hiperalgesia/fisiopatologia , Hiperalgesia/etiologia , Hiperalgesia/metabolismo , Mecanorreceptores/metabolismo , Mecanorreceptores/fisiologia , Masculino , Humanos , Limiar da Dor/fisiologia , Feminino , Medição da Dor , Camundongos Transgênicos , Neuralgia/etiologia , Neuralgia/metabolismo , Neuralgia/fisiopatologia
15.
Zhonghua Yi Xue Za Zhi ; 104(17): 1466-1473, 2024 May 07.
Artigo em Chinês | MEDLINE | ID: mdl-38706052

RESUMO

In order to promote the standardization of the treatment of neuropathic pain by spinal dorsal root entry surgery, alleviate the pain of certain specific neuropathic pain patients, and improve their quality of life and survival, experts with experience in neuropathic pain and spinal dorsal root entry surgery were organized by Functional Neurosurgery Group of the Neurosurgery Branch of the Chinese Medical Association and Functional Neurosurgery Expert Committee of Chinese Congress of Neurological Surgeons to write this consensus. Based on a systematic review and summary of literature and clinical evidence at home and abroad, this consensus discusses the diagnosis and drug treatment of neuropathic pain, clinical application of, spinal dorsal root entry surgery the selection of patients receiving surgery of dorsal root entry zone, preoperative examination, surgical procedures, postoperative management, and the prevention and management of postoperative complications, and forms 12 recommended recommendations, providing reference and guidance for clinical work on the treatment of neuropathic pain through spinal dorsal root entry surgery.


Assuntos
Neuralgia , Raízes Nervosas Espinhais , Humanos , Neuralgia/etiologia , Raízes Nervosas Espinhais/cirurgia , China , Consenso
16.
Presse Med ; 53(2): 104234, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38636786

RESUMO

Neuropathic pain, defined as pain arising as a consequence of a lesion or disease affecting the somatosensory nervous system, requires precise diagnostic assessment. Different diagnostic tools have been devised for the diagnosis of neuropathic pain. This review offers insights into the diagnostic accuracy of screening questionnaires and different tests that investigate the somatosensory nervous system, in patients with suspected neuropathic pain. Thus, it illustrates how these tools can aid clinicians in accurately diagnosing neuropathic pain.


Assuntos
Neuralgia , Medição da Dor , Humanos , Neuralgia/diagnóstico , Neuralgia/etiologia , Medição da Dor/métodos , Inquéritos e Questionários
17.
Anesthesiology ; 141(1): 131-150, 2024 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-38602502

RESUMO

BACKGROUND: Dynamic changes in neuronal activity and in noradrenergic locus coeruleus (LC) projections have been proposed during the transition from acute to chronic pain. Thus, the authors explored the cellular cFos activity of the LC and its projections in conjunction with spontaneous pain-like behavior in neuropathic rats. METHODS: Tyrosine hydroxylase:Cre and wild-type Long-Evans rats, males and females, were subjected to chronic constriction injury (CCI) for 2 (short-term, CCI-ST) or 30 days (long-term, CCI-LT), evaluating cFos and Fluoro-Gold expression in the LC, and its projections to the spinal cord (SC) and rostral anterior cingulate cortex (rACC). These tests were carried out under basal conditions (unstimulated) and after noxious mechanical stimulation. LC activity was evaluated through chemogenetic and pharmacologic approaches, as were its projections, in association with spontaneous pain-like behaviors. RESULTS: CCI-ST enhanced basal cFos expression in the LC and in its projection to the SC, which increased further after noxious stimulation. Similar basal activation was found in the neurons projecting to the rACC, although this was not modified by stimulation. Strong basal cFos expression was found in CCI-LT, specifically in the projection to the rACC, which was again not modified by stimulation. No cFos expression was found in the CCI-LT LCipsilateral (ipsi)/contralateral (contra)→SC. Chemogenetics showed that CCI-ST is associated with greater spontaneous pain-like behavior when the LCipsi is blocked, or by selectively blocking the LCipsi→SC projection. Activation of the LCipsi or LCipsi/contra→SC dampened pain-like behavior. Moreover, Designer Receptor Exclusively Activated by Designer Drugs (DREADDs)-mediated inactivation of the CCI-ST LCipsi→rACC or CCI-LT LCipsi/contra→rACC pathway, or intra-rACC antagonism of α-adrenoreceptors, also dampens pain-like behavior. CONCLUSIONS: In the short term, activation of the LC after CCI attenuates spontaneous pain-like behaviors via projections to the SC while increasing nociception via projections to the rACC. In the long term, only the projections from the LC to the rACC contribute to modulate pain-like behaviors in this model.


Assuntos
Locus Cerúleo , Ratos Long-Evans , Animais , Locus Cerúleo/fisiopatologia , Locus Cerúleo/metabolismo , Ratos , Masculino , Feminino , Comportamento Animal/fisiologia , Fatores de Tempo , Neuralgia/fisiopatologia , Neuralgia/etiologia , Neuralgia/metabolismo , Modelos Animais de Doenças
18.
Medicine (Baltimore) ; 103(16): e37884, 2024 Apr 19.
Artigo em Inglês | MEDLINE | ID: mdl-38640323

RESUMO

INTRODUCTION: Trigeminal herpes zoster, which comprises 10% to 20% of cases of herpes zoster, often leads to severe pain in the ophthalmic branches. Current treatments, including drug therapy and minimally invasive interventions, have limitations; accordingly, there is a need to explore alternative approaches. This study aimed to evaluate the efficacy and safety of computerized tomography (CT)-guided pulsed radiofrequency of the sphenopalatine ganglion in patients with intractable trigeminal herpetic pain. PATIENT CONCERNS: Three patients with intractable trigeminal ophthalmic zoster neuralgia were studied. All patients complained of bursts of headache, which occurred at least 10 times a day, usually in the periorbital and frontal regions. Conventional treatments, including oral medications and radiofrequency therapy targeting the trigeminal-semilunar ganglion and supraorbital nerve, could not sufficiently provide relief. DIAGNOSIS: Two patients were diagnosed with herpes zoster in the ocular branch of the trigeminal nerve with conjunctivitis, while one patient was diagnosed with postherpetic neuralgia in the ocular branch of the trigeminal nerve. INTERVENTIONS: This study employed a novel approach that involved CT-guided radiofrequency regulation of the pterygopalatine fossa sphenopalatine ganglion. OUTCOMES: In all three patients, pain relief was achieved within 1 to 3 days after treatment. During the follow-up, one patient had pain recurrence; however, its severity was ≈ 40% lower than the pretreatment pain severity. The second patient had sustained and effective pain relief. However, the pain of the third patient worsened again after 2 months. The average follow-up duration was 3 months. None of the enrolled patients showed treatment-related adverse reactions or complications. CONCLUSION: Our findings indicated that CT-guided radiofrequency regulation of the pterygopalatine fossa sphenopalatine ganglion was a safe and effective intervention for pain in patients with trigeminal ophthalmic zoster neuralgia, suggesting that it may be a therapeutic option if other treatments fail.


Assuntos
Herpes Zoster Oftálmico , Herpes Zoster , Neuralgia Pós-Herpética , Neuralgia , Dor Intratável , Tratamento por Radiofrequência Pulsada , Neuralgia do Trigêmeo , Humanos , Herpes Zoster Oftálmico/complicações , Herpes Zoster Oftálmico/terapia , Tratamento por Radiofrequência Pulsada/métodos , Neuralgia/etiologia , Neuralgia/terapia , Neuralgia Pós-Herpética/terapia , Neuralgia Pós-Herpética/complicações , Neuralgia do Trigêmeo/terapia , Neuralgia do Trigêmeo/complicações , Herpes Zoster/complicações , Resultado do Tratamento
19.
PLoS One ; 19(4): e0298881, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38626240

RESUMO

INTRODUCTION: Small fiber neuropathy (SFN) is a common cause of neuropathic pain in peripheral neuropathies. Good accessibility of diagnostics and treatment is necessary for an accurate diagnosis and treatment of SFN. Evidence is lacking on the quality performance of the diagnostic SFN service in the Netherlands. Our aim was to determine the patient satisfaction and -accessibility of the diagnostic SFN service, and to identify areas for improvement. METHODS: In a single-center, prospective, survey-based cohort study, 100 visiting patients were asked to fill in the SFN patient satisfaction questionnaire (SFN-PSQ), with 10 domains and 51 items. Cut-off point for improvement was defined as ≥ 25% dissatisfaction on an item. A chi-square test and linear regression analyses was used for significant differences and associations of patient satisfaction. RESULTS: From November 2020 to May 2021, 98 patients with SFN-related complaints filled in the online SFN-PSQ within 20 minutes. In 84% of the patients SFN was confirmed, average age was 55.1 (52.5-57.8) years and 67% was female. High satisfaction was seen in the domains 'Waiting List Period', Chest X-ray', 'Consultation with the Doctor or Nurse Practitioner (NP)', 'Separate Consultation with the Doctor or NP about Psychological Symptoms', and 'General' of the SFN service. Overall average patient satisfaction score was 8.7 (IQR 8-10) on a 1-to-10 rating scale. Main area for improvement was shortening the 8-week period for receiving the results of the diagnostic testing (p < 0.05). General health status was statistically significant associated with patient satisfaction (p < 0.05). CONCLUSION: A good reflection of the high patient satisfaction and -accessibility of the SFN-service is shown, with important points for improvement. These results could help hospitals widely to optimize the logistic and diagnostic pathway of SFN analysis, benchmarking patient satisfaction results among the hospitals, and to improve the quality of care of comparable SFN services.


Assuntos
Neuralgia , Neuropatia de Pequenas Fibras , Humanos , Feminino , Pessoa de Meia-Idade , Estudos de Coortes , Satisfação do Paciente , Estudos Prospectivos , Países Baixos , Inquéritos e Questionários , Neuralgia/etiologia
20.
PLoS One ; 19(4): e0301352, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38662731

RESUMO

OBJECTIVES: The pain associated with osteoarthritis (OA) was thought to be nociceptive; however, neuropathic pain is also observed. We investigated the relationship between hip OA and neuropathic pain using the PainDETECT questionnaire (PDQ). METHODS: A total of 159 hips of 146 consecutive patients who underwent total hip arthroplasty (THA) with a diagnosis of OA were enrolled in this study. The prevalence of each pain phenotype was evaluated preoperatively and at 6 months postoperatively using the PDQ. Patient characteristics and numerical rating scale (NRS) scores were compared between a group with possible neuropathic pain (NP group) and a group with nociceptive pain (non-NP group). RESULTS: Before THA, neuropathic, unclear, and nociceptive pain was observed in 18, 36, and 105 hips, respectively. The prevalence in the NP group was 54 hips, accounting for approximately one-third of all hips, which decreased significantly to seven hips after THA. A significantly higher NRS score was observed in the NP group, both before and after THA. CONCLUSION: Approximately one-third of the patients with hip OA had neuropathic pain. Therefore, neuropathic pain should be considered when treating patients with hip OA.


Assuntos
Artroplastia de Quadril , Neuralgia , Osteoartrite do Quadril , Humanos , Artroplastia de Quadril/efeitos adversos , Feminino , Neuralgia/etiologia , Neuralgia/epidemiologia , Masculino , Osteoartrite do Quadril/cirurgia , Osteoartrite do Quadril/complicações , Idoso , Pessoa de Meia-Idade , Medição da Dor , Inquéritos e Questionários , Idoso de 80 Anos ou mais
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