Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 3.749
Filtrar
1.
Ther Umsch ; 77(6): 281-286, 2020 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-32930076

RESUMO

The role of the reconstructive surgeon treating neuropathic pain after iatrogenic nerve lesions Abstract. Any surgical intervention bears the potential risk of iatrogenic nerve lesions with consecutive functional deficits and chronic neuropathic pain syndromes. These complications obviously result in patient dissatisfaction and frequently bear legal consequences. A broad experience in diagnosis and treatment of peripheral nerve lesions is needed to initiate the proper diagnostics and treatment modalities in an according time frame. The quick and appropriate response after any nerve trauma is an important criterion for success or failure of the reconstruction. Surgeons from other specialities, who do not deal with nerve lesions in their daily routine, need a distinct overview about diagnostics and treatment, to initiate the adequate therapy shortly after the injury. This review provides an overview of peripheral nerve lesions, the underlying pathomechanisms, the diagnosis and reconstructive treatment options. Even with highest accuracy and experience, nerve lesions are part of any surgical practice. However, we are convinced that with adequate and prompt action of the primary surgeon a good patient-doctor relationship may be maintained, often more favourable results may be achieved after reconstruction and legal trials avoided.


Assuntos
Neuralgia/diagnóstico , Neuralgia/etiologia , Cirurgiões , Humanos , Doença Iatrogênica , Nervos Periféricos
2.
Medicine (Baltimore) ; 99(34): e21507, 2020 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-32846761

RESUMO

BACKGROUND: In recent years, some studies indicated that repetitive transcranial magnetic stimulation (rTMS) could relieve neuropathic pain (NP) following a spinal cord injury (SCI), whereas some studies showed no pain relief effect. In addition, some studies showed the analgesic effect of transcranial direct current stimulation (tDCS) on NP post SCI, whereas other studies showed no effect. METHODS: We systematically searched on the PubMed, Web of Science, EMBASE, Medline, Google Scholar for studies exploring the analgesic effect of rTMS or tDCS on NP post SCI until November 2019. Meta-analysis was conducted to summarize results of these studies. RESULTS: The present quantitative meta-analysis indicated no significant difference in the effect of treatment on NP following SCI between rTMS and sham rTMS over the motor cortex at about 1 week after the end of the rTMS period (standardized mean difference (SMD) = 2.89, 95% confidence interval (CI) = -0.27 to 6.04). However, the study indicated that rTMS showed significantly better pain relief of treatment compared with sham rTMS between 2 and 6 weeks after the end of the rTMS period (SMD = 3.81, 95%CI: 0.80-7.52). However, no sufficient evidence could be provided to make a meta-analysis for the analgesic effect of tDCS on NP following SCI over the primary motor area (M1). CONCLUSIONS: In conclusion, the present meta-analysis suggested that rTMS did not show early analgesic effect on NP after SCI, but showed better middle-term analgesic effect, compared with sham rTMS. More large scale, blinded randomized controlled trials (RCTs) were needed to explore the analgesic effect of rTMS and tDCS on NP following SCI.


Assuntos
Neuralgia/terapia , Traumatismos da Medula Espinal/reabilitação , Estimulação Transcraniana por Corrente Contínua , Estimulação Magnética Transcraniana , Humanos , Neuralgia/etiologia , Traumatismos da Medula Espinal/complicações
3.
BMC Surg ; 20(1): 147, 2020 Jul 06.
Artigo em Inglês | MEDLINE | ID: mdl-32631293

RESUMO

BACKGROUND: Chronic postsurgical pain (CPSP) after hernia repair research has mainly relied on unconfirmed self-reporting. We aimed to describe confirmed CPSP incidence, management, and quality of life (QoL) in a 2-year prospective study. METHODS: Multicenter study (GENDOLCAT) of 3890 patients undergoing 4 common surgical procedures in 23 hospitals to develop a risk model for CPSP; 2352 men underwent open hernia repair. Patients with pain were identified by telephone at 1 and 3 months and referred to the hospital 4 months after surgery for a physical examination to confirm CPSP. Three validated tools were used: the Brief Pain Inventory (BPI) for severity, analgesic use, and interference with activities; the SF-12 questionnaire for QoL (validated Spanish version), and the Douleur Neuropathique 4 (DN4). Patients with CPSP were called again at 1 and 2 years. RESULTS: In 1761 patients who underwent hernia repair and were eligible for physical examination for CPSP, the incidence of confirmed pain at 4 months was 13.6% (patient-reported pain, 6.2% at 1 year and 4.0% at 2 years). Neuropathic pain was diagnosed in 38.5% of the CPSP patients at 4 months. The incidences of neuropathic CPSP in patients with mesh or non-mesh repairs were similar (38.6 and 33.3%, respectively). SF-12 physical component scores changed little in all patients, whether or not they developed CPSP. The SF-12 mental component decreased significantly in all patients, but the decrease was clinically significant only in CPSP patients. CPSP interfered with activities (18%), work (15.6%), walking (15%) and mood (10.2%). At 2 years 52.1% of CPSP patients had moderate/intense pain and 28.2% took analgesics. CONCLUSION: CPSP affects QoL-related activities, and although it diminishes over the course of 2 years after surgery, many patients continue to have moderate/intense pain and take analgesics. CPSP and neuropathic pain rates seem to be similar after mesh and non-mesh repair. BPI and SF-12 mental component scores detect effects on QoL. TRIAL REGISTRATION: ClinicalTrials.gov NCT01510496.


Assuntos
Dor Crônica/etiologia , Herniorrafia/métodos , Dor Pós-Operatória/etiologia , Qualidade de Vida , Adulto , Idoso , Analgésicos/administração & dosagem , Virilha/cirurgia , Hérnia Inguinal/cirurgia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Neuralgia/etiologia , Estudos Prospectivos , Inquéritos e Questionários
5.
BMJ Case Rep ; 13(7)2020 Jul 08.
Artigo em Inglês | MEDLINE | ID: mdl-32641309
7.
Medicine (Baltimore) ; 99(25): e20484, 2020 Jun 19.
Artigo em Inglês | MEDLINE | ID: mdl-32569170

RESUMO

BACKGROUND: This study will explore the efficacy and safety of intrathecal baclofen bolus (IBB) on neuropathic pain (NPP) in patients with spinal cord injury (SCI). METHODS: All potential literatures of IBB on NPP in patients with SCI will be searched from the following electronic databases from inauguration to the January 31, 2020: PUBMED, EMBASE, Cochrane Library, Web of Science, Chinese Scientific Journal Database Information, WANGFANG, and China National Knowledge Infrastructure. In addition, we will search other sources, such as dissertations and reference lists of included trials. There are no restrictions of language and publication status in searching all literature sources. The quality of each eligible trial will be assessed using Cochrane risk of bias tool, and publication bias will be checked using a funnel plot and Egger test. Statistical analysis will be conducted using RevMan 5.3 software. RESULTS: This study will scrutinize the efficacy and safety of IBB on NPP in patients with SCI through pain intensity of NPP, spasticity, walking ability, health-related quality of life, duration of stay at hospital (days), incidence of adverse event, and mortality rate. CONCLUSIONS: The findings of this study will present helpful evidence to judge whether IBB is effective on NPP in patients with SCI or not. STUDY REGISTRATION NUMBER: INPLASY202040192.


Assuntos
Baclofeno/administração & dosagem , Relaxantes Musculares Centrais/administração & dosagem , Neuralgia/tratamento farmacológico , Traumatismos da Medula Espinal/complicações , Humanos , Injeções Espinhais , Metanálise como Assunto , Neuralgia/etiologia , Revisões Sistemáticas como Assunto
8.
Medicine (Baltimore) ; 99(25): e20702, 2020 Jun 19.
Artigo em Inglês | MEDLINE | ID: mdl-32569202

RESUMO

BACKGROUND: This protocol aims to assess the efficacy and safety of Botulinum Toxin Type A (BTTA) for the treatment of neuropathic pain (NPP) in patients with spinal cord injury (SCI). METHODS: We will retrieve databases in Cochrane Library, EMBASE, MEDLINE, Excerpta Medica Database, PsychINFO, the Allied and Complementary Medicine Database, and Chinese Biomedical Literature Database, and China National Knowledge Infrastructure from the beginning to the March 1, 2020. We will consider any potential studies on assessing the efficacy and safety of BTTA for the treatment of NPP in patients with SCI without limitations of language and publication status. Cochrane risk of bias will be used to assess the risk of bias for all included trials. RevMan 5.3 software will be utilized to synthesize the extracted data and to analyze those data. RESULTS: This study will appraise the efficacy and safety based on the current evidence of BTTA for the treatment of NPP in patients with SCI. CONCLUSION: This study will exert high quality clinical trials for exploring the efficacy and safety of BTTA in treating NPP in patients with SCI. PROSPERO REGISTRATION NUMBER: PROSPERO CRD42020170474.


Assuntos
Toxinas Botulínicas Tipo A/uso terapêutico , Neuralgia/tratamento farmacológico , Neuralgia/etiologia , Fármacos Neuromusculares/uso terapêutico , Traumatismos da Medula Espinal/complicações , Humanos , Metanálise como Assunto , Revisões Sistemáticas como Assunto
9.
J Vasc Interv Radiol ; 31(6): 917-924, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32376175

RESUMO

PURPOSE: To evaluate the safety and efficacy of cryoneurolysis (CNL) in patients with refractory thoracic neuropathic pain related to tumor invasion. MATERIALS AND METHODS: Between January 2013 and May 2017, this single-center and retrospective study reviewed 27 computed tomography-guided CNLs performed on 26 patients for refractory thoracic neuropathic pain related to tumor invasion. Patients with cognitive impairment were excluded. Pain levels were recorded on a visual analog scale (VAS) before the procedure, on days 1, 7, 14, 28 and at each subsequent follow-up appointment. CNL was clinically successful if the postprocedural VAS decreased by 3 points or more. To determine the duration of clinical success, the end of pain relief was defined as either an increased VAS of 2 or more points, the introduction of a new analgesic treatment, a death with controlled pain, or for lost to follow-up patients, the latest follow-up appointment date with controlled pain. RESULTS: Technical success rate was 96.7% and clinical success rate was 100%. Mean preprocedural pain score was 6.4 ± 1.7 and decreased to 2.4 ± 2.4 at day 1; 1.8 ± 1.7 at day 7 (P < .001); 3.3 ± 2.5 at day 14; 3.4 ± 2.6 at day 28 (P < .05). The median duration of pain relief was 45 days (range 14-70). Two minor complications occurred. CONCLUSIONS: Cryoneurolysis is a safe procedure that significantly decreased pain scores in patients with thoracic neuropathic pain related to tumor invasion, with a median duration of clinical success of 45 days.


Assuntos
Criocirurgia , Denervação/métodos , Neoplasias/complicações , Neuralgia/cirurgia , Manejo da Dor/métodos , Dor Intratável/cirurgia , Nervos Torácicos/cirurgia , Adolescente , Adulto , Idoso , Criocirurgia/efeitos adversos , Denervação/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica , Neoplasias/diagnóstico por imagem , Neoplasias/patologia , Neuralgia/diagnóstico , Neuralgia/etiologia , Neuralgia/fisiopatologia , Manejo da Dor/efeitos adversos , Medição da Dor , Dor Intratável/diagnóstico , Dor Intratável/etiologia , Dor Intratável/fisiopatologia , Estudos Retrospectivos , Nervos Torácicos/diagnóstico por imagem , Nervos Torácicos/fisiopatologia , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
10.
World Neurosurg ; 139: e316-e324, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32298822

RESUMO

BACKGROUND: Although spinal decompression surgery is an effective treatment for myelopathy-induced upper limb pain, some postoperative patients suffer from residual pain in spite of adequate decompression. However, the neural mechanism underlying the poor outcome of pain relief is still unclear. The goal of this study was to explore the brain mechanisms involved in the poor recovery of upper limb pain after the spinal decompression surgery by using functional connectivity (FC) analysis. METHODS: In this cross-sectional study, 17 patients who underwent cervical spinal decompression surgery were included. Functional MRI (fMRI) during a tactile stimulus for each hand was performed at 1 day before and 7 days after the surgery. In total, 34 fMRI scans (17 left and right upper limbs, respectively) were obtained before and after the surgery, respectively. The patients were divided into poor-recovery and good-recovery groups, and then we searched for the FC that was related to poor-recovery. RESULTS: The poor-recovery group (n = 15) showed significantly stronger connectivity between the postcentral gyrus (postCG) and dorsolateral prefrontal cortex (DLPFC) than the good-recovery group (n = 12) preoperatively. When the cutoff value of the preoperative FC between the left postCG and right middle frontal gyrus included in DLPFC was >0.17, the sensitivity and specificity for poor recovery were 73% and 75%, respectively. CONCLUSIONS: Our study showed that FC between the postCG and DLPFC may be a predictor of pain relief. This result suggested that assessing FC can lead to more informed surgical interventions for cervical spondylotic myelopathy.


Assuntos
Encéfalo/fisiopatologia , Vias Neurais/fisiopatologia , Neuralgia/fisiopatologia , Estenose Espinal/cirurgia , Idoso , Vértebras Cervicais , Estudos Transversais , Descompressão Cirúrgica , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Neuralgia/etiologia , Neuralgia/cirurgia , Fusão Vertebral , Estenose Espinal/etiologia , Espondilose/complicações , Espondilose/cirurgia , Resultado do Tratamento
11.
Neurology ; 94(18): e1900-e1907, 2020 05 05.
Artigo em Inglês | MEDLINE | ID: mdl-32269109

RESUMO

OBJECTIVE: To determine whether Scrambler therapy is an effective, acceptable, and feasible treatment of persistent central neuropathic pain in patients with neuromyelitis optica spectrum disorder (NMOSD) and to explore the effect of Scrambler therapy on co-occurring symptoms. METHODS: We conducted a randomized single-blind, sham-controlled trial in patients with NMOSD who have central neuropathic pain using Scrambler therapy for 10 consecutive weekdays. Pain severity, pain interference, anxiety, depression, and sleep disturbance were assessed at baseline, at the end of treatment, and at the 30- and 60-day follow-up. RESULTS: Twenty-two patients (11 per arm) were enrolled in and completed this trial. The median baseline numeric rating scale (NRS) pain score decreased from 5.0 to 1.5 after 10 days of treatment with Scrambler therapy, whereas the median NRS score did not significantly decrease in the sham arm. Depression was also reduced in the treatment arm, and anxiety was decreased in a subset of patients who responded to treatment. These symptoms were not affected in the sham arm. The safety profiles were similar between groups. CONCLUSIONS: Scrambler therapy is an effective, feasible, and safe intervention for central neuropathic pain in patients with NMOSD. Decreasing pain with Scrambler therapy may additionally improve depression and anxiety. CLINICALTRIALSGOV IDENTIFIER: NCT03452176. CLASSIFICATION OF EVIDENCE: This study provides Class II evidence that Scrambler therapy significantly reduces pain in patients with NMOSD and persistent central neuropathic pain.


Assuntos
Neuralgia/terapia , Neuromielite Óptica/complicações , Neuromielite Óptica/terapia , Manejo da Dor/métodos , Estimulação Elétrica Nervosa Transcutânea/métodos , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neuralgia/etiologia , Método Simples-Cego
12.
BMC Neurol ; 20(1): 117, 2020 Apr 02.
Artigo em Inglês | MEDLINE | ID: mdl-32241253

RESUMO

BACKGROUND: We report on a patient with a mild traumatic brain injury (TBI) who developed abdominal pain due to spinothalamic tract (STT) injuries revealed by diffusion tensor tractography (DTT). CASE PRESENTATION: A 53-year-old female patient suffered head trauma resulting from a backward fall. While bathing at a public bathhouse, she fell backward and struck the occipital area of her head against the floor. After the head trauma, she experienced pain in the abdomen and in both hands and feet. She underwent evaluations including conventional brain MRI, abdominal and pelvic ultrasonography, and stomach and intestine endoscopy. No abnormality was observed in her brain or abdomen. In addition, her abdominal pain had not been relieved by medical management. When she came to our hospital 4 years after the head trauma, her pain characteristics and severity were as follows: intermittent pain without allodynia or hyperalgesia; squeezing and warm creeping-like pain in the abdomen (visual analog scale score: 7); tingling pain in both hands and feet (visual analog scale score: 7). She was prescribed pregabalin and gabapentin, and her abdominal and limb pain was well-controlled at a tolerable level. On DTT 4 years after head trauma, the upper portion of the spinothalamic tracts (STTs) in both hemispheres showed partial tearing. DISCUSSION AND CONCLUSIONS: Injury of the STT was demonstrated by using DTT in a patient who showed abdominal pain that was refractory to medical management following mild TBI. Our results suggest that central pain due to STT injury might be suspected in patients with abdominal pain that is refractory to medical management following TBI.


Assuntos
Dor Abdominal/etiologia , Concussão Encefálica/patologia , Tratos Espinotalâmicos/lesões , Acidentes por Quedas , Concussão Encefálica/diagnóstico por imagem , Imagem de Tensor de Difusão , Feminino , Humanos , Pessoa de Meia-Idade , Neuralgia/diagnóstico por imagem , Neuralgia/etiologia , Tratos Espinotalâmicos/diagnóstico por imagem
13.
Braz J Med Biol Res ; 53(5): e9255, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32348427

RESUMO

The neurochemical mechanisms underlying neuropathic pain (NP) are related to peripheral and central sensitization caused by the release of inflammatory mediators in the peripheral damaged tissue and ectopic discharges from the injured nerve, leading to a hyperexcitable state of spinal dorsal horn neurons. The aim of this work was to clarify the role played by cyclooxygenase (COX) in the lesioned peripheral nerve in the development and maintenance of NP by evaluating at which moment the non-steroidal anti-inflammatory drug indomethacin, a non-selective COX inhibitor, attenuated mechanical allodynia after placing one loose ligature around the nervus ischiadicus, an adaptation of Bennett and Xie's model in rodents. NP was induced in male Wistar rats by subjecting them to chronic constriction injury (CCI) of the nervus ischiadicus, placing one loose ligature around the peripheral nerve, and a sham surgery (without CCI) was used as control. Indomethacin (2 mg/kg) or vehicle was intraperitoneally and acutely administered in each group of rats and at different time windows (1, 2, 4, 7, 14, 21, and 28 days) after the CCI or sham surgical procedures, followed by von Frey's test for 30 min. The data showed that indomethacin decreased the mechanical allodynia threshold of rats on the first, second, and fourth days after CCI (P<0.05). These findings suggested that inflammatory mechanisms are involved in the induction of NP and that COX-1 and COX-2 are involved in the induction but not in the maintenance of NP.


Assuntos
Indometacina/administração & dosagem , Neuralgia/tratamento farmacológico , Medição da Dor , Nervo Isquiático/lesões , Animais , Constrição , Modelos Animais de Doenças , Masculino , Neuralgia/etiologia , Limiar da Dor , Ratos , Ratos Sprague-Dawley , Ratos Wistar
14.
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
15.
Phys Ther ; 100(6): 946-962, 2020 06 23.
Artigo em Inglês | MEDLINE | ID: mdl-32201890

RESUMO

BACKGROUND: Pain is one of the main symptoms associated with spinal cord injury (SCI) and can be associated with changes to the central nervous system (CNS). PURPOSE: This article provides an overview of the evidence relating to CNS changes (structural and functional) associated with pain in SCIs. DATA SOURCES: A systematic review was performed, according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations, on PubMed, Embase, and Web of Science in March 2018. STUDY SELECTION: Studies were selected if they concerned changes in the CNS of patients with SCI, regardless of the type of imagery. DATA EXTRACTION: Data were extracted by 2 blinded reviewers. DATA SYNTHESIS: There is moderate evidence for impaired electroencephalographic function and metabolic abnormalities in the anterior cingulate in patients experiencing pain. There is preliminary evidence that patients with pain have morphological and functional changes to the somatosensory cortex and alterations to thalamic metabolism. There are conflicting data regarding the relationships between lesion characteristics and pain. In contrast, patients without pain can display protective neuroplasticity. LIMITATIONS AND CONCLUSION: Further studies are required to elucidate fully the relationships between pain and neuroplasticity in patients with SCIs. However, current evidence might support the use of physical therapist treatments targeting CNS plasticity in patients with SCI pain.


Assuntos
Sistema Nervoso Central/patologia , Sistema Nervoso Central/fisiopatologia , Dor Crônica/etiologia , Neuralgia/etiologia , Traumatismos da Medula Espinal/complicações , Adulto , Encéfalo/diagnóstico por imagem , Encéfalo/metabolismo , Encéfalo/patologia , Encéfalo/fisiopatologia , Sistema Nervoso Central/diagnóstico por imagem , Sistema Nervoso Central/metabolismo , Dor Crônica/fisiopatologia , Eletroencefalografia/métodos , Giro do Cíngulo/diagnóstico por imagem , Giro do Cíngulo/fisiopatologia , Humanos , Imagem por Ressonância Magnética/métodos , Neuralgia/fisiopatologia , Neuroimagem/métodos , Plasticidade Neuronal/fisiologia , Viés de Seleção , Córtex Somatossensorial/diagnóstico por imagem , Córtex Somatossensorial/patologia , Córtex Somatossensorial/fisiopatologia , Medula Espinal/diagnóstico por imagem , Medula Espinal/metabolismo , Medula Espinal/patologia , Medula Espinal/fisiopatologia , Traumatismos da Medula Espinal/diagnóstico por imagem , Traumatismos da Medula Espinal/metabolismo , Traumatismos da Medula Espinal/fisiopatologia , Tálamo/diagnóstico por imagem , Tálamo/metabolismo
16.
Am J Phys Med Rehabil ; 99(9): 811-820, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32175926

RESUMO

OBJECTIVE: The aim of the study was to examine the effectiveness of noninvasive brain stimulation on neuropathic pain in individuals with spinal cord injury. METHODS: A meta-analysis on pain intensity, depression, and anxiety levels was conducted to evaluate the effect of noninvasive brain stimulation on neuropathic pain in individuals with spinal cord injury. The authors searched Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (PubMed), Embase (OvidSP), PsycINFO (OvidSP), and Physiotherapy Evidence Database (PEDro). Randomized controlled trials comparing noninvasive brain stimulation with sham stimulation were included. RESULTS: Eleven studies were selected. The pooled analysis demonstrated no significant effect of repetitive transcranial magnetic stimulation, transcranial direct current stimulation, or cranial electrotherapy stimulation on neuropathic pain reduction after spinal cord injury. In addition, noninvasive brain stimulation showed no beneficial effect over sham stimulation on the improvement of depression, while it yielded a significant reduction of anxiety levels immediately after treatment. Subgroup analysis showed that only cranial electrotherapy stimulation had a significant effect on the reduction of anxiety levels among the three types of noninvasive brain stimulation. CONCLUSIONS: In individuals with spinal cord injury, no significant effects of noninvasive brain stimulation on neuropathic pain and depression were observed. Cranial electrotherapy stimulation may be beneficial for the management of anxiety. These findings do not support the routine use of noninvasive brain stimulation for neuropathic pain in individuals with spinal cord injury.


Assuntos
Dor Crônica/terapia , Terapia por Estimulação Elétrica/estatística & dados numéricos , Neuralgia/terapia , Manejo da Dor/métodos , Traumatismos da Medula Espinal/complicações , Adulto , Encéfalo , Dor Crônica/etiologia , Método Duplo-Cego , Terapia por Estimulação Elétrica/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neuralgia/etiologia , Medição da Dor , Ensaios Clínicos Controlados Aleatórios como Assunto , Estimulação Transcraniana por Corrente Contínua/métodos , Estimulação Transcraniana por Corrente Contínua/estatística & dados numéricos , Estimulação Magnética Transcraniana/métodos , Estimulação Magnética Transcraniana/estatística & dados numéricos , Resultado do Tratamento
17.
Medicine (Baltimore) ; 99(13): e19629, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32221089

RESUMO

Acute postsurgical pain, probably including acute neuropathic pain (ANeP), starts at the early postoperative period, and chronic postsurgical pain including chronic neuropathic pain (CNeP) persists at least 3 months after surgery. Although it must be important for prevention and treatment of acute and chronic postoperative pain to reveal the time course of postoperative neuropathic characteristics, a neuropathic pain profile after surgery has not been evaluated.Pain status at the surgical site in adult patients who underwent video-assisted thoracic surgery (VATS) for lung cancer was prospectively assessed until 12 months after surgery. Neuropathic characteristics were assessed using the Douleur Neuropathique 4 (DN4) questionnaire until 6 days after surgery and the DN2 questionnaire throughout the study.Twenty-seven patients were enrolled in this study. Pain intensity at surgical sites were significantly higher at 1 and 6 days after surgery during resting state, and were also significantly higher at 3, 6, and 12 months after surgery during movement than those before surgery. The incidence of ANeP was 33.3% at 1 day, and 18.5% at 6 days after surgery. The incidence of CNeP decreased to 12.5% at 3 months, 5.0% at 6 months, and 0.0% at 12 months after surgery. The number of neuropathic characteristics, assessed by DN2 scores, significantly increased at 1 and 6 days after surgery, compared to those before surgery. DN2 scores at 3, 6, and 12 months after surgery, however, showed no significant differences compared to those before surgery.In patients with acute postsurgical pain, 20% to 30% of patients show ANeP characteristics, and the incidence of CNeP gradually decreases after VATS in patients with chronic postsurgical pain.


Assuntos
Neuralgia/etiologia , Dor Pós-Operatória/epidemiologia , Cirurgia Torácica Vídeoassistida/efeitos adversos , Dor Aguda , Idoso , Idoso de 80 Anos ou mais , Dor Crônica , Feminino , Humanos , Incidência , Neoplasias Pulmonares/cirurgia , Masculino , Pessoa de Meia-Idade , Medição da Dor , Assistência Perioperatória , Estudos Prospectivos , Fatores de Risco
18.
Pain Physician ; 23(1): 23-35, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-32013276

RESUMO

BACKGROUND: Pharmacologic treatment is not successful in all cases of postmastectomy pain syndrome (PMPS). Some patients continue suffering pain while taking their medications, and others cannot tolerate the side effects of antineuropathic analgesics. Radiofrequency technology has provided promising results in the management of chronic neuropathic pain. OBJECTIVES: Considering that affection of intercostobrachial nerves are the main reason behind PMPS, we aimed to evaluate and compare the analgesic efficacy of pulsed radiofrequency (PRF) when delivered either on thoracic dorsal root ganglion (DRG) of intercostobrachial nerves (thoracic DRG 2, 3, and 4) or their corresponding thoracic paravertebral nerves (PVNs). STUDY DESIGN: Prospective randomized-controlled clinical trial. SETTINGS: Interventional pain unit, tertiary center, university hospital. METHODS: Sixty-four patients complaining of PMPS were randomized to either group DRG (n = 32) that received PRF on thoracic DRG, or group PVN (n = 32) that received PRF on thoracic PVN. The outcome variables were that the patients showed > 50% reduction in their visual analog scale (VAS) pain score; the VAS pain score and global perceived effect (GPE) was evaluated during a 6-month follow-up period. RESULTS: The percentage of patients who showed > 50% reduction of their VAS pain score was significantly higher in group DRG compared with group PVN, assessed at 4 and 6 months postprocedure (23/29:79.3% vs. 13/29:44.8%; P = 0.007) and (22/29:75.9% vs. 7/29:24.1%; P < 0.001), respectively, however, the 2 groups did not significantly differ at 1, 2, and 3 months postprocedure (DRG vs. PVN), (21/29: 72.4% vs. 21/29: 72.4%; P = 0.542), (24/29: 82.8% vs. 23/29: 79.9%; P = 0.778), and (24/29: 82.8% vs. 19/29: 65.5%; P = 0.136), respectively. There was a statistically significant reduction of VAS pain score at 4 and 6 months (DRG vs. PVN, mean ± standard deviation, 2.9 ± 2 vs. 3.9 ± 1.5; mean difference (95% confidence interval), 1 (0.06:1.9); P = 0.038; 3 ± 1.94 vs. 5.1 ± 1.5; mean difference (95% confidence interval), 1.9 (1:2.9); P < 0.001, respectively), however, the 2 groups did not significantly differ at 1, 2, and 3 months postprocedure. With regard to the patient's satisfaction (i.e., GPE), assessed at 3 and 6 months postprocedure, there was a significantly higher satisfaction in group DRG compared with group PVN (median [interquartile range (IQR)], 6 (5:7) vs. 3 (2:4);P < 0.001), however, the patient's satisfaction was similar between groups at 3 months postprocedure: median (IQR), 6 (4:7) vs. 6 (5:6); P = 0.327. LIMITATIONS: The study follow-up period is limited to 6 months only. CONCLUSIONS: PRF of both the thoracic DRG and the thoracic PVN are effective treatments for PMPS; however, PRF of DRG provided a better long-term analgesic effect. Nevertheless, given the inherent risk of performing thoracic foraminal interventions and the technical difficulty of targeting thoracic DRG, we recommend that PRF of DRG should be reserved for cases that failed to gain adequate response to PRF of thoracic PVN in conjunction with medical treatment. KEY WORDS: Postmastectomy pain syndrome, radiofrequency, dorsal root ganglion, paravertebral nerve.


Assuntos
Gânglios Espinais , Mastectomia/efeitos adversos , Dor Pós-Operatória/terapia , Tratamento por Radiofrequência Pulsada/métodos , Nervos Torácicos , Adulto , Neoplasias da Mama/cirurgia , Dor Crônica/etiologia , Dor Crônica/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neuralgia/etiologia , Neuralgia/terapia , Satisfação do Paciente , Estudos Prospectivos , Resultado do Tratamento
19.
BMC Neurol ; 20(1): 61, 2020 Feb 18.
Artigo em Inglês | MEDLINE | ID: mdl-32070321

RESUMO

BACKGROUND: We report a patient with unusual occipital neuropathic pain (at-level neuropathic pain) due to a small central cervical spinal cord injury (SCI). CASE PRESENTATION: A 50-year-old man presented with severe bilateral occipital pain after falling from a height of 2 m, 2 weeks ago. The degree of pain was evaluated to be 9 out of 10 using the numeric rating scale (NRS). The nature of the pain was tingling, burning, and piercing, and hyperalgesia was present over the bilateral posterior head regions. Greater occipital nerve block with bupivacaine and dexamethasone was not effective. On axial T2-cervical magnetic resonance imaging (MRI), a focal high signal change was observed in the central portion of the spinal cord at the C2 level. We deliberated that the patient's pain was due to the SCI observed on MRI, and after administration of oral medications, the NRS pain score reduced from 9 to 2. CONCLUSIONS: Neuropathic pain caused by SCI varies according to the location and degree of injury of the pain-related neural tracts; therefore, clinicians should closely observe the pain patterns and findings on imaging in patients with SCI to determine the cause of pain accurately.


Assuntos
Medula Cervical/lesões , Neuralgia/etiologia , Traumatismos da Medula Espinal/complicações , Medula Cervical/patologia , Humanos , Hiperalgesia/etiologia , Masculino , Pessoa de Meia-Idade
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA