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1.
Pain Manag ; 12(1): 75-85, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34289734

RESUMO

Aim: Chronic postsurgical pain (CPSP) is a common complication of surgery. This study was conducted to evaluate the efficacy and safety of paresthesia-free, 10-kHz spinal cord stimulation (SCS) as a treatment for CPSP. Patients & methods: Subjects in this prospective, single-arm study had an average pain intensity of ≥5 cm on a 10-cm visual analog scale. The subjects who had pain relief of ≥50% (response) with temporary trial stimulation were permanently implanted with 10-kHz SCS and assessed for 1 year. Results: At 12 months, 94% of subjects were responders to 10-kHz SCS, and 88% had pain remission (visual analog scale ≤2.5 cm). Conclusion: The pain relief was durable in CPSP subjects and the safety profile of 10-kHz SCS was as expected. Clinical Trial registration number: VT005076953 (Privacy Commission of Belgium).


Assuntos
Dor Crônica , Neuralgia , Estimulação da Medula Espinal , Bélgica , Dor Crônica/terapia , Humanos , Neuralgia/etiologia , Neuralgia/terapia , Dor Pós-Operatória/terapia , Estudos Prospectivos , Medula Espinal , Resultado do Tratamento
2.
Pol Merkur Lekarski ; 49(293): 379-381, 2021 Oct 22.
Artigo em Polonês | MEDLINE | ID: mdl-34800029

RESUMO

According to International Association for the Study of Pain (IASP) neuropathic pain is defined as a pain caused by a lesion or disease of the somatosensory nervous system. In general population 7-8% adults suffer from chronic pain with neuropathic characteristic. The most common causes include: lumbar radiculopathy, postherpetic neuropathy, HIV infection, autoimmune diseases (multiple sclerosis), metabolic diseases (diabetic neuropathy), stroke or spinal cord injury. Current pharmacotherapy of neuropathic pain has insufficient effectiveness, so comprehension of neuropathic pain mechanism is necessary for research of new therapeutic methods. In the study we verify the analgesic effect of maraviroc (antagonist of the chemokine receptor - CCR5) and its potential role in the treatment of neuropathic pain. In the study we focused on dependency between opioid and chemokine receptors, because of similar structure between this receptors occurs cross-desensitization phenomenon. Chemokine antagonist maraviroc belongs to a group of entry inhibitors, antiretroviral drug. It enhances analgesic properties of opioids by inhibition of crossdesensitization of opioid's receptor. Application of maraviroc with morphine can reduce effective dosage of morphine 2,3 fold. Moreover, research show that prophylactic administration of maraviroc without opioid analgesics suppresses development of neuropathic pain symptoms. It has influence on glial phenotype, decreases secretion of proinflammatory cytokines and increases anti-inflammatory cytokine secretion. Furthermore it decreases expression of chemikine receptor mRNA and chemikine ligand's secreted by microglia and astrocytes as a result of nerve injury. We conclude that maraviroc has immunomodulatory properties, potentiates opioid analgesics effect, and can be used in neuropathic pain therapy as a potential co-analgesic.


Assuntos
Infecções por HIV , Neuralgia , Analgésicos Opioides , Infecções por HIV/complicações , Humanos , Maraviroc , Morfina , Neuralgia/tratamento farmacológico , Neuralgia/etiologia
3.
J Oral Facial Pain Headache ; 35(3): 218-229, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34609380

RESUMO

AIMS: To conduct a systematic review compiling an update on the pathophysiology of burning mouth syndrome (BMS) by reviewing the theories and studies published in the last 5 years that consider BMS a neuropathic disease. METHODS: A literature review was carried out in April 2020 on the PubMed database by using the following MeSH terms: "(burning mouth OR burning mouth syndrome OR burning mouth pain OR sore mouth OR burning tongue OR oral neuropathic pain OR glossodynia OR stomatopyrosis) AND (etiopathogenesis OR etiopathological factors OR etiology)." RESULTS: The research carried out according to the methodology found 19 case-control studies (1 of which was in vivo) and 1 RCT. Of the 19 included studies, 8 showed an evidence score of 2-; 8 showed 2+; another 2 showed 2++; and 1 showed 1+. Quality studies on this topic are insufficient and heterogenous. CONCLUSION: In the pathogenesis of BMS, both peripheral and central neuropathies appear to play a pivotal role. Nevertheless, the balance between them varies from case to case and tends to overlap. BMS does not seem to be a result of direct damage to the somatosensory nervous system, but a dysfunction in it and in the brain network.


Assuntos
Síndrome da Ardência Bucal , Neuralgia , Síndrome da Ardência Bucal/etiologia , Estudos de Casos e Controles , Humanos , Neuralgia/etiologia
4.
Cancer Treat Res ; 182: 17-25, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34542873

RESUMO

Pain from cancer can present in a multitude of ways. In this chapter, we will identify the types of cancer pain and their etiologies. Following this, we will explore how cancer pain can present as somatic pain, visceral pain, and neuropathic pain. We will explore the aspects of the history and physical examination that point to specific diagnoses of pain and how to appropriately treat each diagnosis appropriately. Finally, we will touch upon a phenomenon known as opioid neurotoxicity.


Assuntos
Dor do Câncer , Neoplasias , Neuralgia , Analgésicos Opioides , Humanos , Neoplasias/complicações , Neuralgia/etiologia , Síndrome
5.
Ceska Gynekol ; 86(4): 279-283, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34493054

RESUMO

OBJECTIVE: General practitioners, surgeons, neurologists, urologists and gynecologists all encounter patients suffering from neurogenic pelvic pain. Correct management demands knowledge from all above mentioned specialties. The primary goal is to help patients suffering from chronic or acute pelvic pain coupled with functional disorders like dysuria, urgency, dyspareunia, mobility disorders orhypoesthesia. Neurogenic defects are not the most common etiology for either of listed symptoms. However, after exclusion of the more common ones and failure to respond to basic therapeutic methods such as physiotherapy or analgotheraphy doctors tend to mark the illness as idiopathic and incurable. The goal of this review is to show the most common nosological units and a robust dia-gnostic algorithm to describe the type and level of the damage. METHODS: Review of literature using databases Pubmed, Science direct, Medline and sources of the international school of neuropelveology. CONCLUSION: Over a lifetime, one in seven women will suffer from chronic pelvic pain. Outside of the cases where a clear postoperative etiology is established, the time to make a correct dia-gnosis is often long for the unspecific and varied symptomatology. Neuropelveological dia-gnostic algorithm is demonstrably efficient in shortening the time to dia-gnosis and more importantly to the treatment.


Assuntos
Dor Crônica , Neuralgia , Diagnóstico Diferencial , Feminino , Humanos , Neuralgia/diagnóstico , Neuralgia/etiologia , Neuralgia/terapia , Dor Pélvica/diagnóstico , Dor Pélvica/etiologia , Dor Pélvica/terapia , Pelve
6.
Neurol India ; 69(4): 910-915, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34507411

RESUMO

Objective: This study aims to evaluate the effects of transforaminal epidural steroid injection (TFESI) on neuropathic pain (NP) in patients with chronic unilateral radiculopathy due to lumbar disc herniation (LDH). Patients and Methods: Between September 2018 and April 2019, a total of 61 patients who were diagnosed with unilateral/unilevel radiculopathy due to LDH and were scheduled for single-level TFESI were included in this study. The Numeric Rating Scale (NRS), modified Oswestry Disability Index (ODI), Beck Depression Inventory (BDI), and NP-Douleur Neuropathique 4 Questionnaire (DN4) were used before the procedure and at 1 hour, 3 weeks, and 3 months after the procedure. Results: There was a significant decrease in the NRS and significant improvement in the ODI, BDI, and DN4 scores in all patients at all postprocedural timepoints (P < 0.05). The number of patients with NP decreased from 35 (60.3%) at baseline to 23 (41.2%) at 3 months (P = 0.001). The NRS scores were similar at 3 weeks and 3 months between the patients with and without NP (P > 0.05). The ODI scores were significantly higher at 3 months in the patients with NP than those without NP (P = 0.013). The BDI scores at baseline, 3 weeks, and 3 months were significantly higher in the patients with NP than those without NP (P < 0.001, P = 0.016, and P = 0.016, respectively). Conclusion: Our study results suggest that TFESI is an effective and safe method to decrease not only nociceptive but also NP component in patients with chronic radiculopathy due to LDH. Clinicians should keep in mind that NP is a risk factor that adversely affects the TFESI success and patients should be evaluated before the procedure.


Assuntos
Deslocamento do Disco Intervertebral , Neuralgia , Radiculopatia , Humanos , Injeções Epidurais , Deslocamento do Disco Intervertebral/complicações , Deslocamento do Disco Intervertebral/tratamento farmacológico , Vértebras Lombares , Neuralgia/tratamento farmacológico , Neuralgia/etiologia , Estudos Prospectivos , Radiculopatia/tratamento farmacológico , Esteroides/uso terapêutico , Resultado do Tratamento
7.
Praxis (Bern 1994) ; 110(12): 673-680, 2021 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-34521273

RESUMO

Neuropathic Pain - Differential Diagnosis and Treatment from the Hand Surgeon's Perspective Abstract. Neuropathic pain of the wrist and hand can be caused by a multitude of pathologies, such as trauma, iatrogenic damage, local peripheral nerve compression, nerve tumors and systemic diseases. Neuropathic pain can lead to chronification and disability, severely affecting the patients' quality of life and the ability to work. A precise diagnosis is the key to an adequate therapy with satisfactory functional results. An interdisciplinary and multimodal approach is a prerequisite when treating neuropathic pain. This review article provides an insight into the diagnosis and therapy of pathologies associated with neuropathic pain of the wrist and hand.


Assuntos
Neuralgia , Cirurgiões , Diagnóstico Diferencial , Mãos/cirurgia , Humanos , Neuralgia/diagnóstico , Neuralgia/etiologia , Neuralgia/terapia , Qualidade de Vida
8.
Artigo em Inglês | MEDLINE | ID: mdl-34501513

RESUMO

Emerging literature suggests that virtual reality (VR) may be a viable therapy for neuropathic pain (NP). This pilot study aimed to investigate the immediate effect of VR in reducing NP in people with spinal cord injury (SCI). Eight individuals with chronic NP after SCI were recruited and underwent consecutive exposure to scenery and somatic virtual environments (VE). The numeric rating scale (NRS) was used to assess pain before and after exposure to each VE. The Immersive Tendencies Questionnaire (ITQ) and Presence Questionnaire (UQO-PQ) were used to investigate the interaction between reported pain relief post-intervention with immersion and presence. There was a significant reduction in pain levels (5.1 ± 0.4, mean ± SEM) after short exposure to the scenery (3.1 ± 0.7, p = 0.04) and somatic VE (3.0 ± 0.7, p = 0.04), with no difference between intervention types (p = 0.56). There was a statistically significant negative correlation between the total ITQ score and the change in NRS after the scenery VR intervention (rs = 0.743, p = 0.035). PQ scores showed no significant correlation with changes in pain following either intervention type. We found that short-term exposure to VR environments results in a reduction in chronic NP intensity in people with SCI.


Assuntos
Neuralgia , Traumatismos da Medula Espinal , Terapia de Exposição à Realidade Virtual , Realidade Virtual , Humanos , Neuralgia/etiologia , Neuralgia/terapia , Projetos Piloto
9.
Einstein (Sao Paulo) ; 19: eAO6256, 2021.
Artigo em Inglês, Português | MEDLINE | ID: mdl-34586159

RESUMO

OBJECTIVE: To assess the quantitative serum levels of tropomyosin receptor kinase receptor B, and to estimate its association with serum concentration of brain-derived neurotrophic factor and obesity in patients with painful and painless forms of diabetic polyneuropathy. METHODS: We examined 70 patients with diabetic polyneuropathy with confirming peripheral nerve dysfunction by electroneuromyography and measuring of serum levels tropomyosin receptor kinase receptor B and brain-derived neurotrophic factor by enzyme immunoassay. Diabetic polyneuropathy was diagnosed using the modified Toronto Consensus (2011) criteria, while neuropathic pain was assessed using an 11-point Numerical Pain Rating Scale. The patients were divided into two groups according to presence or absence of neuropathic pain. Control Group consisted of 14 healthy persons. RESULTS: The serum levels of tropomyosin receptor kinase receptor B and brain-derived neurotrophic factor in patients with diabetic polyneuropathy are significantly higher than healthy controls (p=0.000). Hyperexpression of brain-derived neurotrophic factor in serum was associated with painful form of diabetic polyneuropathy (R=0.392, p=0.012) and obesity (R=0.412, p=0.001). On the contrary high concentration of tropomyosin receptor kinase receptor B in serum associated with painless diabetic polyneuropathy by Pain DETECT (R=-0.354, p=0.015), low body weight (R=-0.354, p=0.015) and severe demyelization of nerve fibers (R=-0.574, p=0.001), indicated "non-working" receptor detected in serum. CONCLUSION: Tropomyosin receptor kinase receptor B signaling is involved in the modulation of neuropathic pain and obesity in diabetic polyneuropathy.


Assuntos
Diabetes Mellitus , Neuropatias Diabéticas , Neuralgia , Humanos , Neuralgia/etiologia , Obesidade/complicações , Tropomiosina
10.
Spinal Cord Ser Cases ; 7(1): 72, 2021 08 07.
Artigo em Inglês | MEDLINE | ID: mdl-34365469

RESUMO

INTRODUCTION: Chronic neuropathic pain (NeP) often develops following traumatic spinal cord injury (SCI). This case report explores variability in clinical and neurophysiological aspects of pain evaluation in early post-trauma stages. CASE PRESENTATION: A 34-year old female presenting with acute incomplete sensorimotor tetraplegia C4 AIS D was examined by neurological examination and pain assessment at three time points after acute trauma T1 (8 weeks), T2 (11 weeks), and T3 (24 weeks). Quantitative sensory testing (QST) and laser-evoked potentials (LEPs) were measured above (control area), at (area of NeP), and below (foot) the neurological level of injury (NLI). Musculo-skeletal and neuropathic pain were clinically present already during T1 but showed variations in localization and occurrence over time. Neuropathic pain classification varied between time points due to shifting of NLI. Above-level QST revealed minor, less pronounced abnormalities similar to at-level site. At-level QST (site of NeP) showed loss for thermal and mechanical detection thresholds but also gain of function for mechanical pain thresholds with a tendency of amelioration over time. QST below-level did not reveal remarkable changes over time. LEPs above- and below-level were within normal limits. At-level LEPs abolished after T1. DISCUSSION: In early stages post injury (up to 6 month) variations in pain presentation for both, musculo-skeletal and neuropathic pain as well as QST and LEP could be demonstrated. These findings suggest ongoing adaption mechanisms in sensory pathways, which require further exploration and may be relevant for prognostic and preventive strategies against the development of chronic neuropathic and nociceptive pain.


Assuntos
Neuralgia , Traumatismos da Medula Espinal , Adulto , Feminino , Humanos , Neuralgia/diagnóstico , Neuralgia/etiologia , Exame Neurológico , Medição da Dor , Limiar da Dor , Traumatismos da Medula Espinal/diagnóstico
11.
Zh Nevrol Psikhiatr Im S S Korsakova ; 121(7. Vyp. 2): 22-30, 2021.
Artigo em Russo | MEDLINE | ID: mdl-34387442

RESUMO

Among the numerous pain syndromes (PS) of various localizations and types, observed in patients with multiple sclerosis (MS), the greatest attention of researchers is attracted by neuropathic PS. Neuropathic PS are often present already in the early stage of MS, significantly reduce the quality of life, hinder the social adaptation of patients, poorly respond to therapy. Central neuropathic PS, which pathogenesis is closely related with plaques in the central nervous system, are most common in patients with MS. Diagnostics of neuropathic PS in MS is based mainly on typical clinical symptoms; MRI and neurophysiological methods data are of secondary importance. This review focuses on modern concepts of three main neuropathic PS in MS: ongoing extremity pain, trigeminal neuralgia and Lhermitte's sign. Clinical symptoms of neuropathic PS, current ideas about their pathogenetic mechanisms, MRI and neurophysiological techniques data and the existing approaches to conservative therapy and surgical treatment based on randomized trials data are presented.


Assuntos
Esclerose Múltipla , Neuralgia , Neuralgia do Trigêmeo , Humanos , Esclerose Múltipla/complicações , Esclerose Múltipla/terapia , Neuralgia/diagnóstico , Neuralgia/etiologia , Neuralgia/terapia , Qualidade de Vida , Síndrome
12.
J Hand Surg Asian Pac Vol ; 26(3): 390-395, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34380411

RESUMO

Background: Traumatic neuromas are a result of abnormal neural regeneration after nerve injury. Neuropathic pain arising from neuroma can be debilitating. Methods: This was a retrospective review of a consecutive series of patients who presented with a painful cutaneous neuroma secondary to direct trauma or surgery. The diagnosis was made by the presence of neuropathic symptoms in the dermatome of a cutaneous nerve and a positive Tinel sign. Local anaesthetic injection was performed for confirmation of diagnosis. Each patient was offered optimisation of medical therapy and physiotherapy for desensitisation. Outpatient neuromodulation was offered as an alternative to neuroma surgery. The primary aim of treatment was symptom reduction such that neuroma surgery was no longer required. Results: This study included 50 patients with painful cutaneous neuromas. Surgery was the commonest cause. The most frequently injured nerves were superficial radial nerve, digital nerve and dorsal ulnar cutaneous nerve, together comprising over 60% of cases. After receiving neuromodulation, 18 (36%) patients experienced sufficient symptom relief and did not wish to pursue neuroma surgery. Conclusions: Surgery is the commonest cause of a painful cutaneous neuroma. Following optimisation of pharmacotherapy and physiotherapy, neuromodulation may offer symptom relief such that neuroma surgery may be avoided in approximately one third of cases.


Assuntos
Neuroma , Neoplasias do Sistema Nervoso Periférico , Humanos , Neuralgia/etiologia , Neuralgia/terapia , Neuroma/cirurgia , Pacientes Ambulatoriais , Estudos Retrospectivos
13.
Diabetes Care ; 44(8): 1835-1841, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34385346

RESUMO

OBJECTIVE: Impaired rate-dependent depression of the Hoffman reflex (HRDD) is a marker of spinal inhibitory dysfunction and has previously been associated with painful neuropathy in a proof-of-concept study in patients with type 1 diabetes. We have now undertaken an assessment of HRDD in patients with type 1 or type 2 diabetes. RESEARCH DESIGN AND METHODS: A total of 148 participants, including 34 healthy control subjects, 42 patients with painful diabetic neuropathy, and 62 patients with diabetic neuropathy without pain, underwent an assessment of HRDD and a detailed assessment of peripheral neuropathy, including nerve conduction studies, corneal confocal microscopy, and thermal threshold testing. RESULTS: Compared with healthy control subjects (P < 0.001) and patients without pain (P < 0.001), we found that HRDD is impaired in patients with type 1 or type 2 diabetes with neuropathic pain. These impairments are unrelated to diabetes type and the presence or severity of neuropathy. In contrast, patients without neuropathic pain (P < 0.05) exhibited enhanced HRDD compared with control subjects. CONCLUSIONS: We suggest that loss or impairment of HRDD may help to identify a subpopulation of patients with painful diabetic neuropathy mediated by impaired spinal inhibitory systems who may respond optimally to therapies that target spinal or supraspinal mechanisms. Enhanced RDD in patients without pain may reflect engagement of spinal pain-suppressing mechanisms.


Assuntos
Diabetes Mellitus Tipo 1 , Diabetes Mellitus Tipo 2 , Neuropatias Diabéticas , Neuralgia , Córnea , Diabetes Mellitus Tipo 1/complicações , Diabetes Mellitus Tipo 2/complicações , Humanos , Neuralgia/diagnóstico , Neuralgia/etiologia
14.
J Palliat Med ; 24(10): 1579-1581, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34314620

RESUMO

Background: Scrambler therapy (ST) is a relatively new neuromodulation technique that is useful in treatment of medication-resistant pain syndromes, including chemotherapy-induced peripheral neuropathy and other chronic pain syndromes. Amyloidosis commonly leads to peripheral neuropathy, and although the mechanism is unclear, it is possibly related to amyloid deposits on the nerve. Case Presentation: In this case presentation, we describe the novel use of ST for a patient with 13 years of neuropathic pain related to amyloidosis and worsened by chemotherapy. The patient reported bilateral hand pain with burning and aching and bilateral numbness on the soles of her feet. Her upper extremities were treated with 4 days of 40 minute ST treatment sessions providing reduction in her pain scores to zero. Discussion: Current therapy for amyloid peripheral neuropathy aims at treating the underlying condition, and then medical management with gabapentinoids. This is first case presentation showing successful treatment with ST.


Assuntos
Amiloidose , Neuralgia , Amiloidose/tratamento farmacológico , Feminino , , Humanos , Neuralgia/tratamento farmacológico , Neuralgia/etiologia , Manejo da Dor , Medição da Dor
15.
Aging (Albany NY) ; 13(14): 18606-18619, 2021 07 29.
Artigo em Inglês | MEDLINE | ID: mdl-34326272

RESUMO

This study focused on the relationship between extracellular-regulated kinase (ERK) and obesity-induced increases in neuropathic pain. We fed rats a high-fat diet to establish the obesity model, and rats were given surgery to establish the chronic compression of the dorsal root ganglia (CCD) model. U0126 was applied to inhibit ERK, and metformin or 5-aminoimidazole-4-carboxamide ribonucleoside (AICAR) was applied to cause AMP-activated protein kinase (AMPK) activation. Paw withdrawal mechanical threshold (PWMT) were calculated to indicate the level of neuropathic pain. The data indicated that compared with normal CCD rats, the PWMT of obese CCD rats were decreased, accompanied with an increase of ERK phosphorylation, NAD(P)H oxidase 4 (NOX4) protein expression, oxidative stress and inflammatory level in the L4 to L5 spinal cord and dorsal root ganglia (DRG). Administration of U0126 could partially elevate the PWMT and reduce the protein expression of NOX4 and the above pathological changes in obese CCD rats. In vitro, ERK phosphorylation, NOX4 protein expression increased significantly in DRG neurons under the stimulation of palmitic acid (PA), accompanied with increased secretion of inflammatory factors, oxidative stress and apoptosis level, while U0126 partially attenuated the PA-induced upregulation of NOX4 and other pathological changes. In the rescue experiment, overexpression of NOX4 abolished the above protective effect of U0126 on DRG neurons in high-fat environment. Next, we explore upstream mechanisms. Metformin gavage significantly reduced neuropathic pain in obese CCD rats. For the mechanisms, activating AMPK with metformin (obese CCD rats) or AICAR (DRG neurons in a high-fat environment) not only inhibited the ERK-NOX4 pathway, but also improved oxidative stress and inflammation caused by high-fat. In conclusion, the AMPK-ERK-NOX4 pathway may has a pivotal role in mediating obesity-induced increases in neuropathic pain.


Assuntos
Proteínas Quinases Ativadas por AMP/metabolismo , Gânglios Espinais , Sistema de Sinalização das MAP Quinases , NADPH Oxidase 4/metabolismo , Neuralgia/etiologia , Obesidade/complicações , Medula Espinal , Aminoimidazol Carboxamida/análogos & derivados , Aminoimidazol Carboxamida/farmacologia , Animais , Apoptose , Butadienos/farmacologia , Dieta Hiperlipídica , Modelos Animais de Doenças , Inibidores Enzimáticos/farmacologia , Gânglios Espinais/metabolismo , Gânglios Espinais/patologia , Hipoglicemiantes/farmacologia , Inflamação , Masculino , Metformina/farmacologia , Neuralgia/metabolismo , Nitrilas/farmacologia , Obesidade/metabolismo , Estresse Oxidativo , Limiar da Dor , Fosforilação , Ratos Wistar , Ribonucleotídeos/farmacologia , Medula Espinal/metabolismo , Medula Espinal/patologia
16.
Biochem Biophys Res Commun ; 569: 147-153, 2021 09 10.
Artigo em Inglês | MEDLINE | ID: mdl-34245979

RESUMO

Currently, limited information regarding the role of calcitonin gene-related peptide (CGRP) in neuropathic pain is available. Intracerebroventricular administrations of an anti-CGRP antibody were performed in rats with infraorbital nerve ligation. Anti-CGRP antibody administration attenuated mechanical and heat hypersensitivities induced by nerve ligation and decreased the phosphorylated extracellular signal-regulated kinase expression levels in the trigeminal spinal subnucleus caudalis (Vc) following mechanical or heat stimulation. An increased CGRP immunoreactivity in the Vc appeared after nerve ligation. A decreased CGRP immunoreactivity resulted from anti-CGRP antibody administration. Our findings suggest that anti-CGRP antibody administration attenuates the symptoms of trigeminal neuropathic pain by acting on CGRP in the Vc.


Assuntos
Anticorpos Monoclonais/farmacologia , Peptídeo Relacionado com Gene de Calcitonina/imunologia , Temperatura Alta , Hipersensibilidade/prevenção & controle , Estresse Mecânico , Traumatismos do Nervo Trigêmeo/complicações , Animais , Anticorpos Monoclonais/administração & dosagem , Anticorpos Monoclonais/imunologia , Peptídeo Relacionado com Gene de Calcitonina/metabolismo , MAP Quinases Reguladas por Sinal Extracelular/metabolismo , Hipersensibilidade/etiologia , Imuno-Histoquímica , Masculino , Microscopia Confocal , Neuralgia/etiologia , Neuralgia/prevenção & controle , Fosforilação , Ratos Wistar , Núcleo Espinal do Trigêmeo/metabolismo
17.
BMC Neurol ; 21(1): 296, 2021 Jul 27.
Artigo em Inglês | MEDLINE | ID: mdl-34311723

RESUMO

BACKGROUND: Neurolymphomatosis (NL) is a rare manifestation of malignant lymphoma that shows selective infiltration to the peripheral nervous system primarily or secondarily. We report a patient with secondary NL caused by germinal center B-cell (GCB)-type diffuse large B-cell lymphoma (DLBCL) who showed selective infiltration of the lumbar plexus to the spinal cord and massive nerve enlargement resulting in severe pain. CASE PRESENTATION: A 72-year-old female exhibited asymmetric motor and sensory impairments and pain in the lower limbs that progressed for five months. Magnetic resonance imaging (MRI) showed an enlarged lumbar plexus, which continued to the cauda equina via the L3 and L4 spinal nerves. Her symptoms gradually worsened. Ten months after the onset of symptoms, the enlarged cauda equina filled the spinal canal space, and the spinal cord was swollen. A cauda equina biopsy was performed, and she was diagnosed with GCB-type DLBCL with CD10 positivity. The primary tumor was found in a mammary cyst. The autopsy study did not show apparent infiltration, except in the nervous system. CONCLUSIONS: Although there are many neurologic phenotypes of malignant lymphoma, the association between the cytological characteristics of lymphoma and the neurological phenotypes is still unclear. Several reports of CD10-positive secondary NL are available, whereas peripheral or central nervous tissue origin lymphoma cases are mostly negative for CD10. CD10 staining may be useful for distinguishing primary NL from secondary NL. NL often has a strong organotropism for peripheral nervous tissue, which makes early diagnosis challenging.


Assuntos
Plexo Lombossacral , Linfoma Difuso de Grandes Células B , Neurolinfomatose , Idoso , Cauda Equina/diagnóstico por imagem , Cauda Equina/patologia , Evolução Fatal , Feminino , Humanos , Plexo Lombossacral/diagnóstico por imagem , Plexo Lombossacral/patologia , Linfoma Difuso de Grandes Células B/diagnóstico por imagem , Linfoma Difuso de Grandes Células B/patologia , Imageamento por Ressonância Magnética , Neuralgia/etiologia , Neurolinfomatose/secundário
19.
BMJ Case Rep ; 14(7)2021 Jul 22.
Artigo em Inglês | MEDLINE | ID: mdl-34301704

RESUMO

A 61-year-old man with no significant medical history developed fever, headache and mild shortness of breath. He tested positive for SARS-CoV-2 and self-isolated at home, not requiring hospital admission. One week after testing positive, he developed acute severe burning pain affecting his whole body, subsequently localised distally in the limbs. There was no ataxia or autonomic failure. Neurological examination was unremarkable. Electrophysiological tests were unremarkable. Skin biopsy, lumbar puncture, enhanced MRI of the brachial plexus and MRI of the neuroaxis were normal. His pain was inadequately controlled with pregabalin but improved while on a weaning regimen of steroids. This case highlights the variety of possible symptoms associated with SARS-CoV-2 infection.


Assuntos
COVID-19 , Neuralgia , Febre , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Neuralgia/diagnóstico , Neuralgia/tratamento farmacológico , Neuralgia/etiologia , SARS-CoV-2
20.
J Med Case Rep ; 15(1): 378, 2021 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-34261538

RESUMO

BACKGROUND: Neuritis of the infrapatellar branch of the saphenous nerve can result from iatrogenic injury, entrapment, bursitis, or patellar dislocation. Currently, there is an unmet clinical need for treating refractory neuritis nonsurgically. CASE PRESENTATION: Three patients presented with persistent anterior knee pain caused by neuritis of the infrapatellar branch of the saphenous nerve that had got excellent but only temporary relief from steroid and local anesthetic nerve block. The neuropathic pain diagnostic Douleur Neuropathique 4 questionnaire and painDETECT questionnaire confirmed presence of neuropathic pain. After injection with 25 mg amniotic and umbilical cord particulate, the patient's pain decreased from 7.3 before injection to 0.3 at 6 weeks postinjection. In addition, neuropathic symptoms significantly improved at 2 weeks and were not present by 6 weeks. By 63 weeks, two of the patients reported continued complete pain relief, while one patient underwent total knee replacement due to an allergy of a previously implanted unicondylar implant. CONCLUSIONS: This case series suggests that amniotic and umbilical cord particulate may be a viable alternative to reduce pain in patients with neuropathic pain.


Assuntos
Artroplastia do Joelho , Neuralgia , Neurite (Inflamação) , Humanos , Joelho , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/cirurgia , Neuralgia/etiologia , Neuralgia/terapia
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