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1.
Zhen Ci Yan Jiu ; 46(3): 209-14, 2021 Mar 25.
Artigo em Chinês | MEDLINE | ID: mdl-33798293

RESUMO

OBJECTIVE: To observe the effect of electroacupuncture (EA) on the behavior, histomorphology and the expression of angiopoietin-1 (Angpt-1) in rats with spinal nerve injury, so as to explore its mechanism on neuropathic pain. METHODS: Forty-five male SD rats were randomly divided into sham, model and EA groups (n=15 rats in each group). Spinal nerve ligation (SNL) of the L5 lumbar vertebra was performed to establish a rat model of neuropathic pain. The rats in the EA group were given EA at "Zusanli" (ST36) and "Kunlun" (BL60) of the operation side with continuous wave at a frequency of 2 Hz and an intensity of 1.5 mA once a day, 30 minutes each time for 7 days. The sham group only exposed L5 spinal nerves without ligation. Mechanical withdrawal threshold (MWT) and thermal withdrawal latency (TWL) were observed and recorded before modeling and on days 3,5,7,10,12 and 14 after modeling. L4-L6 segments of spinal cord were taken and the morphological changes of spinal dorsal horn were observed by HE staining. The changes of spinal dorsal horn nerve fiber structure were observed by silver plating staining. Angpt-1 expression was detected by Western blot and immunohistochemistry. RESULTS: Compared with the sham group, the model group had significant reductions in MWT and TWL at each time point (P<0.01); compared with the model group, the EA group had significant increases in MWT and TWL on days 10,12 and 14 after intervention (P<0.05, P<0.01). HE staining showed that in the model group, the spinal dorsal horn showed degeneration and necrosis of neurons, nuclear fixation and shrinkage, and loose surrounding tissues. The degree of tissue damage of the EA group was milder than that of the model group. The silver staining results showed the model group had obvious neuronal fibrillary tangles, while there were fewer neuronal fibrillary tangles in the EA group. Compared with the sham group, the Angpt-1 expression in the model group was significantly decreased (P<0.01), and compared with the model group, the EA group had a significant increase in the expression of Angpt-1 (P<0.01). CONCLUSION: EA can promote the recovery of nerve function in SNL rats by up-regulating Angpt-1 expression.


Assuntos
Eletroacupuntura , Neuralgia , Angiopoietina-1/genética , Animais , Masculino , Neuralgia/genética , Neuralgia/terapia , Ratos , Ratos Sprague-Dawley , Medula Espinal , Corno Dorsal da Medula Espinal
2.
Undersea Hyperb Med ; 48(1): 13-23, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33648029

RESUMO

Neuropathic pain (NPP) refers to the pain caused by primary or secondary injury or dysfunction of the peripheral or central nervous system, and usually requires multidisciplinary treatment. However, most pharmacological and non-pharmacological interventions can only temporarily and/or moderately improve pain-related symptoms, and they often produce unbearable adverse reactions or cause drug resistance. Hyperbaric oxygen (HBO2) therapy has been widely used in the clinical treatment of some diseases due to its advantages of safety, few side effects, no resistance, and non-invasiveness. In recent years, increasing numbers of basic and clinical studies have been conducted to investigate the efficacy and mechanism of HBO2 in the treatment of NPP, and great progress has been made in this field. In this paper, we briefly introduce the pathogenesis of NPP and therapeutic effects of HBO2 and summarize the mechanisms underlying the effects of HBO2 in treating NPP, which may provide reference for the clinical treatment of pain with HBO2.


Assuntos
Oxigenação Hiperbárica/tendências , Neuralgia/terapia , Animais , Apoptose/fisiologia , Pressão Atmosférica , Modelos Animais de Doenças , Neurônios GABAérgicos/fisiologia , Humanos , Oxigenação Hiperbárica/métodos , Camundongos , Transtornos de Enxaqueca/terapia , Neuralgia/etiologia , Neurite (Inflamação)/complicações , Óxido Nítrico/fisiologia , Estresse Oxidativo/fisiologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Ratos , Receptores Opioides/fisiologia
3.
Medicine (Baltimore) ; 100(10): e25140, 2021 Mar 12.
Artigo em Inglês | MEDLINE | ID: mdl-33725916

RESUMO

BACKGROUND: Human immunodeficiency virus (HIV)-associated distal symmetric peripheral neuropathy (DSPN) is one of the most frequent neurological complications of HIV infection, and causes pain and dysaesthesias in millions globally. Many individuals with this infection report using acupuncture to manage their symptoms, but evidence supporting the use of acupuncture is limited. This systematic review will assess the effectiveness and safety of acupuncture for patients with HIV-associated DSPN. METHODS: Databases including MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, Scopus, Web of science, AMED (Allied and Complementary Medicine), the Chinese Biomedical Literature Database, the China National Knowledge Infrastructure, Wanfang Database, VIP Database and clinical trials registers (the WHO International Clinical Trials Registry Platform portal and www.ClinicalTrials.gov) will be electronically searched from inception to December 1, 2020. All randomized controlled trials in English or Chinese without restriction on publication status will be included. Selection of studies, extraction of data, and assessment of studies quality will be independently performed by 2 reviewers. The primary outcome measure will be the change in pain intensity assessed by validated scales. Secondary outcomes include change in neurologic summary scores, quality of life, physical function evaluated by admitted tools, and adverse events related to acupuncture reported in the included trials. If possible, a meta-analysis will be conducted to provide an estimate of the pooled treatment effect using Review Manager 5.3 statistical software. Otherwise, qualitative descriptive analysis will be given. The results will be presented as the risk ratio for binary data and the mean difference (MD) or standardized MD for continuous data. RESULTS: The results of the systematic review will be disseminated via publication in a peer-reviewed journal and presented at a relevant conference. CONCLUSION: This review will be the first review entirely focused on assessing the effectiveness and safety of acupuncture for HIV-associated DSPN. PROSPERO REGISTRATION NUMBER: CRD42020210994.


Assuntos
Terapia por Acupuntura/efeitos adversos , Infecções por HIV/complicações , Neuralgia/terapia , Parestesia/terapia , Polineuropatias/terapia , Infecções por HIV/imunologia , Infecções por HIV/virologia , Humanos , Metanálise como Assunto , Neuralgia/diagnóstico , Neuralgia/imunologia , Neuralgia/virologia , Medição da Dor , Parestesia/diagnóstico , Parestesia/imunologia , Parestesia/virologia , Polineuropatias/diagnóstico , Polineuropatias/imunologia , Polineuropatias/virologia , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Índice de Gravidade de Doença , Revisões Sistemáticas como Assunto , Resultado do Tratamento
4.
Medicine (Baltimore) ; 100(6): e24628, 2021 Feb 12.
Artigo em Inglês | MEDLINE | ID: mdl-33578577

RESUMO

INTRODUCTION: Central neuropathic pain can result from any type of injury to the central nervous system. Treatment of central neuropathic pain is very challenging. Recently, a novel stimulation paradigm, called burst stimulation, has been presented as an excellent alternative in a group of patients with intractable central neuropathic pain. We report 2 cases where burst spinal cord stimulation (SCS) was applied in patients with neuropathic pain due to spinal cord injury (SCI) or traumatic brain injury. PATIENT CONCERNS: A 52-year-old man who underwent posterolateral fusion surgery for a T12 bursting fracture after a fall 11 years prior developed disabling pain in the anterolateral part of his right thigh. His neuropathic pain following SCI was refractory to various treatment modalities. A 65-year-old man had complained of intractable, cold, throbbing, and shooting pain mainly in his left lower limb during rehabilitation since undergoing a craniotomy 9 years prior for multiple brain injuries caused by a motorcycle accident. DIAGNOSIS: Both of these 2 cases were diagnosed with central neuropathic pain syndrome caused by SCI or traumatic brain injury. INTERVENTIONS: Burst SCS were proposed to alleviate the significant refractory pains that were resistant to various medications and stimulation was delivered to the patient in an alternating pattern between traditional tonic and burst waveforms. CONCLUSION: The efficacy of burst SCS in central neuropathic pain is desirable considering the severity of pain in such patients, the refractory nature of their pain, and the paucity of alternative therapeutic options.


Assuntos
Lesões Encefálicas Traumáticas/complicações , Neuralgia/terapia , Traumatismos da Medula Espinal/complicações , Estimulação da Medula Espinal , Vértebras Torácicas , Idoso , Humanos , Masculino , Pessoa de Meia-Idade
5.
Trials ; 22(1): 87, 2021 Jan 25.
Artigo em Inglês | MEDLINE | ID: mdl-33494781

RESUMO

BACKGROUND: Spinal cord stimulation (SCS) is an effective method to treat neuropathic pain; however, it is challenging to compare different stimulation modalities in an individual patient, and thus, it is largely unknown which of the many available SCS modalities is most effective. Specifically, electrodes leading out through the skin would have to be consecutively connected to different, incompatible SCS devices and be tested over a time period of several weeks or even months. The risk of wound infections for such a study would be unacceptably high and blinding of the trial difficult. The PARS-trial seizes the capacity of a new type of wireless SCS device, which enables a blinded and systematic intra-patient comparison of different SCS modalities over extended time periods and without increasing wound infection rates. METHODS: The PARS-trial is designed as a double-blinded, randomized, and placebo-controlled multi-center crossover study. It will compare the clinical effectiveness of the three most relevant SCS paradigms in individual patients. The trial will recruit 60 patients suffering from intractable neuropathic pain of the lower extremities, who have been considered for SCS therapy and were already implanted with a wireless SCS device prior to study participation. Over a time period of 35 days, patients will be treated consecutively with three different SCS paradigms ("burst," "1 kHz," and "1.499 kHz") and placebo stimulation. Each SCS paradigm will be applied for 5 days with a washout period of 70 h between stimulation cycles. The primary endpoint of the study is the level of pain self-assessment on the visual analogue scale after 5 days of SCS. Secondary, exploratory endpoints include self-assessment of pain quality (as determined by painDETECT questionnaire), quality of life (as determined by Quality of Life EQ-5D-5L questionnaire), anxiety perception (as determined by the Hospital Anxiety and Depression Scale), and physical restriction (as determined by the Oswestry Disability Index). DISCUSSION: Combining paresthesia-free SCS modalities with wireless SCS offers a unique opportunity for a blinded and systematic comparison of different SCS modalities in individual patients. This trial will advance our understanding of the clinical effectiveness of the most relevant SCS paradigms. TRIAL REGISTRATION: German Clinical Trials Register, DRKS00018929 . Registered on 14 January 2020.


Assuntos
Dor Crônica/terapia , Neuralgia/terapia , Estimulação da Medula Espinal/métodos , Adulto , Dor Crônica/diagnóstico , Estudos Cross-Over , Autoavaliação Diagnóstica , Método Duplo-Cego , Feminino , Humanos , Neuroestimuladores Implantáveis/efeitos adversos , Masculino , Estudos Multicêntricos como Assunto , Neuralgia/diagnóstico , Medição da Dor , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Estimulação da Medula Espinal/efeitos adversos , Estimulação da Medula Espinal/instrumentação , Resultado do Tratamento , Tecnologia sem Fio/instrumentação
6.
Ann Palliat Med ; 10(1): 104-113, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33474954

RESUMO

BACKGROUND: Recently, the role of electroacupuncture (EA) in chronic neuropathic pain has been widely reported. However, its specific mechanisms and ability to mitigate depression-like behaviors induced by chronic pain remains unclear. This study aims to determine the analgesic and antidepressant effect of EA. METHODS: The mechanical threshold sensory and hot plate tests were employed to measure mechanical hyperalgesia and thermal allodynia. The open filed test (OFT) and tail suspension test (TST) were used to observe depressive behavior in chronic constrictive injury (CCI) mice. In addition, the 5-hydroxytryptamine (5-HT) and brain-derived neuropathic factor (BDNF) levels in the anterior cingulate cortex (ACC) and spinal cord were assessed using enzyme-linked immunosorbent assay (ELISA). The protein levels of cAMP-response element-binding protein (CREB) and BDNF in the ACC were analyzed by western blotting. RESULTS: Our results demonstrated that EA treatment could increase the mechanical withdrawal threshold (MWT) and thermal withdrawal latency (TWL) values. Also, EA improved the CCI-induced depression-like behaviors, and significantly reversed the down-regulation of BDNF and 5-HT expression in the ACC and spinal cord after CCI. Furthermore, EA regulated the level of CREB in the ACCs and spinal cords of mice. CONCLUSIONS: These results suggested that the analgesic and antidepressant effect of EA is achieved through regulating CREB-5-HT/BDNF signaling pathway in the ACCs and spinal cords of mice.


Assuntos
Dor Crônica , Eletroacupuntura , Neuralgia , Animais , Dor Crônica/terapia , Depressão/terapia , Hiperalgesia/terapia , Camundongos , Neuralgia/terapia , Ratos , Ratos Sprague-Dawley
7.
Physiol Rev ; 101(1): 259-301, 2021 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-32584191

RESUMO

Neuropathic pain caused by a lesion or disease of the somatosensory nervous system is a common chronic pain condition with major impact on quality of life. Examples include trigeminal neuralgia, painful polyneuropathy, postherpetic neuralgia, and central poststroke pain. Most patients complain of an ongoing or intermittent spontaneous pain of, for example, burning, pricking, squeezing quality, which may be accompanied by evoked pain, particular to light touch and cold. Ectopic activity in, for example, nerve-end neuroma, compressed nerves or nerve roots, dorsal root ganglia, and the thalamus may in different conditions underlie the spontaneous pain. Evoked pain may spread to neighboring areas, and the underlying pathophysiology involves peripheral and central sensitization. Maladaptive structural changes and a number of cell-cell interactions and molecular signaling underlie the sensitization of nociceptive pathways. These include alteration in ion channels, activation of immune cells, glial-derived mediators, and epigenetic regulation. The major classes of therapeutics include drugs acting on α2δ subunits of calcium channels, sodium channels, and descending modulatory inhibitory pathways.


Assuntos
Sistema Nervoso Central/fisiopatologia , Neuralgia/fisiopatologia , Neuralgia/terapia , Animais , Humanos , Fibras Nervosas , Nervos Periféricos/fisiopatologia , Sistema Nervoso Periférico/fisiopatologia
8.
Neurosurgery ; 88(4): 819-827, 2021 03 15.
Artigo em Inglês | MEDLINE | ID: mdl-33372201

RESUMO

BACKGROUND: Secondary to the complex care, involved specialty providers, and various etiologies, chronic pelvic pain patients do not receive holistic care. OBJECTIVE: To compare our general and neuromodulation cohorts based on referrals, diagnosis, and therapy and describe our neuromodulation patients. METHODS: A multidisciplinary team was established at our center. The intake coordinator assessed demographics and facilitated care of enrolled patients. Outcomes were compared using minimal clinical important difference of current Numerical Rating Scale (NRS) between patients with neuropathic pain who received neuromodulation and those who did not. The neuromodulation cohort completed outcome metrics at baseline and recent follow-up, including NRS score (best, worst, and current), Oswestry Disability Index (ODI), Beck Depression Inventory, and Pain Catastrophizing Scale. RESULTS: Over 7 yr, 233 patients were referred to our consortium and 153 were enrolled. A total of 55 patients had neuropathic pain and 44 of those were managed medically. Eleven underwent neuromodulation. A total of 45.5% patients of the neuromodulation cohort were classified as responders by minimal clinically important difference compared to 26.6% responders in the control cohort at most recent follow-up (median 25 and 33 mo, respectively). Outcome measures revealed improvement in NRS at worst (P = .007) and best (P = .025), ODI (P = .014), and Pain Catastrophizing Scale Rumination (P = .043). CONCLUSION: Eleven percent of patients were offered neuromodulation. There were more responders in the neuromodulation cohort than the conservatively managed neuropathic pain cohort. Neuromodulation patients showed significant improvement at 29 mo in NRS best and worst pain, disability, and rumination. We share our algorithm for patient management.


Assuntos
Dor Crônica/terapia , Neuralgia/terapia , Medição da Dor/métodos , Equipe de Assistência ao Paciente , Dor Pélvica/terapia , Estimulação Elétrica Nervosa Transcutânea/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Dor Crônica/diagnóstico , Estudos de Coortes , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Neuralgia/diagnóstico , Dor Pélvica/diagnóstico , Inquéritos e Questionários , Resultado do Tratamento , Adulto Jovem
10.
Medicine (Baltimore) ; 99(51): e23725, 2020 Dec 18.
Artigo em Inglês | MEDLINE | ID: mdl-33371123

RESUMO

BACKGROUND: There is no sufficient evidence on the effectiveness of acupuncture for neuropathic pain. This protocol describes a study that aims to evaluate the effectiveness and safety of electroacupuncture combined with conventional medicine for patients with intractable neuropathic pain, when compared with conventional medicine alone. METHODS/DESIGN: This study is a prospective, open-labeled, randomized, cross-over clinical trial. A total of 40 patients with neuropathic pain who had a numeric rating scale (NRS) score of over 4 despite receiving conventional treatment for more than 3 months will be enrolled. Participants will receive conventional treatment for neuropathic pain (treatment C) or treatment C combined with 12 additional sessions of electroacupuncture treatment (treatment A) for 6 weeks. Participants will be randomly assigned to 1 of the 2 sequence groups (AC and CA group) with a 1:1 allocation. The differences of responder in the composite efficacy outcomes, which consist of the NRS, Brief Pain Inventory-Short Form (BPI-SF) pain subscale, and global assessment at 6 weeks after randomization will be examined as the primary outcome. Secondary outcomes include differences in the NRS, the Short-Form McGill Pain Questionnaire, BPI-SF, Fatigue Severity Scale, Hospital Anxiety and Depression Scale, Medical Outcomes Study Sleep Scale, global assessment, EQ-5D, and incremental cost-effective ratio at 6 and 15 weeks after randomization. Adverse events, vital signs, and physical examinations will be recorded to evaluate safety. DISCUSSION: The study protocol for this trial will provide up-to-date evidence on the effectiveness and safety of electroacupuncture for patients with intractable neuropathic pain. The results will be disseminated through a peer-reviewed journal and conference presentations. TRIAL REGISTRATION: Clinical Research Information Service, ID: KCT0003615. Registered on March 12, 2019. https://cris.nih.go.kr/cris/search/search_result_st01_kren.jsp?seq=13410& ltype=&rtype=.


Assuntos
Eletroacupuntura/métodos , Neuralgia/terapia , Doença Crônica , Análise Custo-Benefício , Estudos Cross-Over , Eletroacupuntura/efeitos adversos , Eletroacupuntura/economia , Fadiga/epidemiologia , Feminino , Humanos , Masculino , Saúde Mental , Medição da Dor , Estudos Prospectivos , Qualidade de Vida , Projetos de Pesquisa , Índice de Gravidade de Doença , Método Simples-Cego
11.
Medicine (Baltimore) ; 99(45): e23077, 2020 Nov 06.
Artigo em Inglês | MEDLINE | ID: mdl-33157973

RESUMO

BACKGROUND: Warm needling acupuncture (WNA) has been widely utilized for pain management in patients with diabetic peripheral neuropathy (DPN). However, its results are still inconsistent, and no systematic review has specifically addressed this issue. Thus, this systematic review will comprehensively and systematically investigate the effectiveness and safety of WNA for pain relief in DPN. METHODS: A comprehensive literature search of MEDLINE, EMBASE, Cochrane Library, Web of Science, Scopus, Allied and Complementary Medicine Database, CBM database, and China National Knowledge Infrastructure will be performed for randomized controlled trials that report WNA for pain relief in patients with DPN. All electronic databases will be searched from initial to the present without limitations of language and publication status. Two investigators will independently screen papers, collect data, and assess study quality. Cochrane risk of bias tool will be used for study quality assessment, and evidence quality will be evaluated using Grading of Recommendations Assessment, Development and Evaluations approach. RevMan 5.3 software will be applied for running statistical analysis. RESULTS: This study will summarize the evidence for the effectiveness and safety of WNA for the management of pain in patients with DPN. CONCLUSIONS: The findings of this study may provide helpful evidence to judge whether WNA for pain relief in DPN is effective or not.


Assuntos
Terapia por Acupuntura/métodos , Neuropatias Diabéticas/terapia , Neuralgia/terapia , Projetos de Pesquisa , Revisões Sistemáticas como Assunto , Temperatura Alta , Humanos , Agulhas , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
12.
Medicine (Baltimore) ; 99(42): e22611, 2020 Oct 16.
Artigo em Inglês | MEDLINE | ID: mdl-33080696

RESUMO

BACKGROUND: Central poststroke pain (CPSP) is a neuropathic pain syndrome that can occur after a cerebrovascular accident. It has negative effects on mood, sleep, rehabilitation, and quality of life in stroke patients. This systematic review assessed the efficacy and safety of nonpharmacological therapies for treating CPSP. METHODS: The Cochrane, PubMed, Embase, and Web of Science databases were systematically searched for studies from inception to August 2020. Two authors worked independently and in duplicate to identify suitable studies. RESULTS: Eleven studies were identified. Pain related to CPSP was ameliorated by precentral gyrus stimulation (P = .01), caloric vestibular stimulation (P = 0.004), transcranial direct current stimulation (P < .05), and bee venom acupuncture point injection (P = .009). Acupuncture (P = .72) and electroacupuncture therapies (P > .05) were as effective for thalamic pain as oral carbamazepine treatment. Motor cortex stimulation, but not deep brain stimulation (DBS), was effective for treating refractory CPSP, and appeared to be more effective than thalamic stimulation for controlling bulbar pain secondary to Wallenberg syndrome. However, DBS in the ventral striatum or anterior limb of the internal capsule improved depression (P = .020) and anxiety in patients with refractory CPSP. Some serious adverse events were reported in response to invasive electrical brain stimulation, but most of these effects recovered with treatment. CONCLUSIONS: Nonpharmacological therapies appear to be effective in CPSP, but the evidence is relatively weak. Invasive electrical brain stimulation can be accompanied by serious adverse events, but most patients recover from these effects.


Assuntos
Neuralgia/terapia , Acidente Vascular Cerebral/complicações , Terapia por Acupuntura , Terapia por Estimulação Elétrica , Humanos , Neuralgia/etiologia , Estimulação Magnética Transcraniana
13.
Artigo em Russo | MEDLINE | ID: mdl-33095534

RESUMO

OBJECTIVE: Sciatic nerve injury in the deep gluteal space is a major clinical problem due to microsurgical manipulations in this region are limited in scope. We offer new endoscopic approach to the sciatic nerve in the deep gluteal space which allows to perform microsurgical manipulations, neurophysiological mapping and electrode installation for the chronic nerve stimulation. MATERIAL AND METHOD: 3 patients with sciatic neuropathy have been operated. Before the operation they suffered from neuropathic pain in the the posterior thigh and calf, reaching 7-8 points on the visual analog scale (VAS). Paresis of triceps surae and biceps femur also was occurred. We performed endoscopic approach to the deep gluteal space through a small incision under the gluteal fold. Microsurgical external and internal decompression of sciatic nerve was performed under the endoscopic control. Next, intra-trunk nerve mapping was performed to visualize sensory fibers. Cylindrical electrodes for chronic neurostimulation were directly placed on the sensory fibers of sciatic nerve. RESULTS: Pain relief was obtained in all cases after activating the simulator, the patient noted a 50% reduction in pain. Muscle straight restoration was observed in all cases 2-3 months later. The clinical effect was stable in the follow up (6 months). CONCLUSION: This technique, combining minimal invasiveness and intraoperative neurophysiological control, makes it possible to optimally position the electrode, both to achieve positive analgesic effect and for potential restoration of nerve function.


Assuntos
Neuralgia , Neuropatia Ciática , Nádegas , Endoscopia , Humanos , Neuralgia/etiologia , Neuralgia/terapia , Nervo Isquiático , Neuropatia Ciática/etiologia , Neuropatia Ciática/cirurgia
14.
PLoS One ; 15(8): e0237156, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32780756

RESUMO

Ischemic neuropathy is common in subjects with critical limb ischemia, frequently causing chronic neuropathic pain. However, neuropathic pain caused by ischemia is hard to control despite the restoration of an adequate blood flow. Here, we used a rat model of ischemic-reperfusion nerve injury (IRI) to investigate possible effects of hepatocyte growth factor (HGF) against ischemic neuropathy. Hemagglutinating virus of Japan (HVJ) liposomes containing plasmids encoded with HGF was delivered into the peripheral nervous system by retrograde axonal transport following its repeated injections into the tibialis anterior muscle in the right hindlimb. First HGF gene transfer was done immediately after IRI, and repeated at 1, 2 and 3 weeks later. Rats with IRI exhibited pronounced mechanical allodynia and thermal hyperalgesia, decreased blood flow and skin temperature, and lowered thresholds of plantar stimuli in the hind paw. These were all significantly improved by HGF gene transfer, as also were sciatic nerve conduction velocity and muscle action potential amplitudes. Histologically, HGF gene transfer resulted in a significant increase of endoneurial microvessels in sciatic and tibial nerves and promoted nerve regeneration which were confirmed by morphometric analysis. Neovascularization was observed in the contralateral side of peripheral nerves as well. In addition, IRI elevated mRNA levels of P2X3 and P2Y1 receptors, and transient receptor potential vanilloid receptor subtype 1 (TRPV1) in sciatic nerves, dorsal root ganglia and spinal cord, and these elevated levels were inhibited by HGF gene transfer. In conclusion, HGF gene transfer is a potent candidate for treatment of acute ischemic neuropathy caused by reperfusion injury, because of robust angiogenesis and enhanced nerve regeneration.


Assuntos
Terapia Genética/métodos , Fator de Crescimento de Hepatócito/genética , Neuralgia/terapia , Traumatismo por Reperfusão/terapia , Animais , Modelos Animais de Doenças , Gânglios Espinais/metabolismo , Técnicas de Transferência de Genes , Vetores Genéticos , Fator de Crescimento de Hepatócito/metabolismo , Humanos , Hiperalgesia/metabolismo , Lipossomos/metabolismo , Masculino , Ratos , Ratos Wistar , Nervo Isquiático/metabolismo , Vírus Sendai/genética , Resultado do Tratamento
15.
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
16.
J Headache Pain ; 21(1): 106, 2020 Aug 26.
Artigo em Inglês | MEDLINE | ID: mdl-32847499

RESUMO

BACKGROUND: Previous studies have reported that electrical stimulation of the motor cortex is effective in reducing trigeminal neuropathic pain; however, the effects of optical motor cortex stimulation remain unclear. OBJECTIVE: The present study aimed to investigate whether optical stimulation of the primary motor cortex can modulate chronic neuropathic pain in rats with infraorbital nerve constriction injury. METHODS: Animals were randomly divided into a trigeminal neuralgia group, a sham group, and a control group. Trigeminal neuropathic pain was generated via constriction of the infraorbital nerve and animals were treated via selective inhibition of calcitonin gene-related peptide in the trigeminal ganglion. We assessed alterations in behavioral responses in the pre-stimulation, stimulation, and post-stimulation conditions. In vivo extracellular recordings were obtained from the ventral posteromedial nucleus of the thalamus, and viral and α-CGRP expression were investigated in the primary motor cortex and trigeminal ganglion, respectively. RESULTS: We found that optogenetic stimulation significantly improved pain behaviors in the trigeminal neuralgia animals and it provided more significant improvement with inhibited α-CGRP state than active α-CGRP state. Electrophysiological recordings revealed decreases in abnormal thalamic firing during the stimulation-on condition. CONCLUSION: Our findings suggest that optical motor cortex stimulation can alleviate pain behaviors in a rat model of trigeminal neuropathic pain. Transmission of trigeminal pain signals can be modulated via knock-down of α-CGRP and optical motor cortex stimulation.


Assuntos
Peptídeo Relacionado com Gene de Calcitonina/deficiência , Neuralgia/fisiopatologia , Neuralgia/terapia , Optogenética , Neuralgia do Trigêmeo/fisiopatologia , Neuralgia do Trigêmeo/terapia , Animais , Masculino , Córtex Motor/fisiopatologia , Ratos , Ratos Sprague-Dawley , Gânglio Trigeminal/lesões , Gânglio Trigeminal/metabolismo
17.
Rev. Soc. Esp. Dolor ; 27(4): 234-238, jul.-ago. 2020. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-196838

RESUMO

INTRODUCCIÓN: La neuroestimulación medular (NM) es una forma de tratamiento del dolor crónico que ha demostrado su efectividad en pacientes que han respondido mal a otras terapias. Las indicaciones actuales para los dispositivos de NM son muy variadas. El objetivo de nuestro estudio es analizar las indicaciones diagnósticas de la terapia con NM durante los últimos 5 años en nuestro hospital, conocer cuáles son las causas de dolor más frecuentes para la indicación del implante del dispositivo y qué porcentaje de mejoría presentan los pacientes, así como estudiar la relación con el género y la edad. MATERIAL Y MÉTODOS: Se trata de un estudio observacional, descriptivo y retrospectivo. Los pacientes fueron identificados desde el registro de actividad quirúrgica de la Unidad del Dolor del Hospital General de Valencia. RESULTADOS: El número final de pacientes incluidos fue de 179. El síndrome de cirugía fallida de espalda (SCFE) fue la indicación diagnóstica en 112 pacientes (62,57 %). La media del porcentaje de mejoría descrita por los pacientes tras el implante del NM fue de 47,99 ± 27,3 %. No se observaron diferencias en la mejoría respecto a la edad o el género. DISCUSIÓN: A pesar de la variabilidad de diagnósticos en los que puede estar indicada esta terapia, es destacable que en más de la mitad de los casos la indicación es por SCFE


INTRODUCTION: Spinal cord stimulation (SCS) is a form of chronic pain treatment that has been shown to be effective in patients who have responded poorly to other therapies. The current indications for SCS devices are very varied. The aim of our study is to analyze the diagnostic indications of SCS therapy during the last 5 years in our hospital, to know the most frequent causes of pain for the indication of the implant of the device and what percentage of improvement patients present, as well as to study the relationship with gender and age. MATERIAL AND METHODS: This is an observational, descriptive, retrospective study. The patients were identified from the surgical activity register of the Pain Unit of the General Hospital of Valencia. RESULTS: The final number of patients included was 179. The Failed back surgery syndrome (FBSS) was the diagnostic indication in 112 patients (62.57 %). The mean percentage of improvement described by the patients after the SCS implant was 47.99 ± 27.3 %. There were no differences in the improvement with respect to age or gender. DISCUSSION: In spite of the variability of diagnoses in which this therapy may be indicated, it is noteworthy that in more than half of the cases the indication is by FBSS


Assuntos
Humanos , Traumatismos da Medula Espinal/terapia , Estimulação da Medula Espinal/métodos , Neuroestimuladores Implantáveis , Dor Lombar/terapia , Dor Crônica/terapia , Manejo da Dor/métodos , Neuralgia/terapia , Cervicalgia/terapia
18.
BMJ Case Rep ; 13(7)2020 Jul 08.
Artigo em Inglês | MEDLINE | ID: mdl-32641309
19.
Pain Physician ; 23(4): 349-364, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32709170

RESUMO

BACKGROUND: Certain types of cancer pain have remained hard to control even by highly skilled pain experts. Uncontrolled cancer pain can have severe effects on quality of life, physical functioning, and leads to psychological distress. From this perspective, nonpharmacologic modalities of treatment are important. Neuromodulatory techniques, such as transcutaneous electrical nerve stimulation and scrambler therapy (ST), have gained popularity in recent times. ST is a relatively new therapy that has been used for the management of cancer pain resistant to pharmacologic management. Several studies have shown that ST is an effective therapy for this type of pain. OBJECTIVES: The aim of this study was to detect possible gaps in the literature regarding the efficacy of ST for cancer pain and formulate recommendations for research through a systematic review of the literature. STUDY DESIGN: A systematic review of the literature was performed following the recommendations of the PRISMA Statement. METHODS: PubMed and EMBASE were searched for studies that met the inclusion criteria using a predetermined search strategy. Reference list of retrieved studies and Google Scholar were used to verify that no relevant studies had been omitted. Data were extracted from the studies with a data extraction sheet. A qualitative analyses of the extracted data was undertaken. RESULTS: Twenty-seven studies were retrieved. Ten were articles that were categorized as literature reviews, including 7 general literature reviews not following a specific review methodology, 1 editorial, and 2 systematic reviews. Seventeen were original studies, including 2 single-arm trials, 1 randomized controlled trial, 4 pilot trials, 4 case reports, 2 retrospective studies, and 4 prospective studies. By and large, the available literature supports the use of ST as an effective therapy for the management of refractory cancer pain. However, the level of evidence for its application to cancer pain is not particularly strong, and improvement in pain with ST may even be owing to a placebo effect. LIMITATIONS: This study was not a meta-review. Because of the limited number of clinical trials on ST in cancer pain, such a meta-review could not meaningfully be performed. CONCLUSIONS: Methodologically sound, large randomized control trials are needed in this area. However at this stage, ST may be considered a good option for cancer patients suffering from pain that does not respond to pharmacologic treatment. KEY WORDS: Scrambler therapy, cancer, cancer pain, neuropathic pain, Calmare therapy, evidence, noninvasive pain treatment, chronic pain.


Assuntos
Dor do Câncer/terapia , Neoplasias/terapia , Manejo da Dor/métodos , Estresse Psicológico/terapia , Dor do Câncer/diagnóstico , Dor do Câncer/psicologia , Dor Crônica/diagnóstico , Dor Crônica/psicologia , Dor Crônica/terapia , Ensaios Clínicos como Assunto/métodos , Humanos , Neoplasias/psicologia , Neuralgia/diagnóstico , Neuralgia/psicologia , Neuralgia/terapia , Estudos Prospectivos , Qualidade de Vida/psicologia , Estudos Retrospectivos , Estresse Psicológico/diagnóstico , Estresse Psicológico/psicologia , Estimulação Elétrica Nervosa Transcutânea/métodos , Resultado do Tratamento
20.
J Headache Pain ; 21(1): 77, 2020 Jun 19.
Artigo em Inglês | MEDLINE | ID: mdl-32560626

RESUMO

An increasing number of patients with chronic persistent post-traumatic headache (PPTH) after mild traumatic brain injury (MTBI) are being referred to headache or pain specialists as conventional treatment options for primary headache disorders have not been able to adequately alleviate their debilitating headache symptoms. Evolving clinical and mechanistic evidences support the notation that chronic persistent MTBI related headaches (MTBI-HA) carry the hallmark characteristics of neuropathic pain. Thus, in addition to conventional treatment options applicable to non-traumatic primary headache disorders, other available treatment modalities for neuropathic pain should be considered. In this comprehensive review article, the author reveals the prevalence of MTBI-HA and its clinical manifestation, discusses existing clinical and mechanistic evidence supporting the classification of chronic persistent MTBI-HA as a neuropathic pain state, and explores current available treatment options and future directions of therapeutic research related to MTBI-HA.


Assuntos
Concussão Encefálica/diagnóstico , Concussão Encefálica/epidemiologia , Transtornos da Cefaleia/diagnóstico , Transtornos da Cefaleia/epidemiologia , Neuralgia/diagnóstico , Neuralgia/epidemiologia , Concussão Encefálica/terapia , Transtornos da Cefaleia/terapia , Humanos , Neuralgia/terapia , Prevalência
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