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1.
Medicine (Baltimore) ; 101(44): e31606, 2022 Nov 04.
Artigo em Inglês | MEDLINE | ID: mdl-36343056

RESUMO

The importance of pain education is widely accepted and recognized. This is a key part of educating the undergraduate and postgraduate healthcare workforce is an essential strategy for promoting effective pain practice. This study aims to evaluate the pain management module training courses for newly graduated doctors to address the knowledge gap between specialist care and primary care physicians. This was an observational study of an evaluation of a pain education project focused on neuropathic pain management core competency was provided. Multimodal teaching approaches such as didactic teaching and vignettes of cases discussion, video teaching, and learning module. A pretest survey was carried out to assess the baseline knowledge of the participants. Completion of the post-test and participant experience questionnaire were collected. Comparison of the pre-and post-test scores for all participants was undertaken using the Wilcoxon signed-ranked test with effect size calculated. The participant's experience questionnaire scores were analyzed descriptively to produce mean and standard deviations from each question. A total of 274 participants completed all of the course sections from the average of 350 eligible participants. Of 274 participants, more than half were female (64.96%), with more than half participants being General Practitioner (54.38%) followed by a neurologist (35.04%). For all sessions, a Wilcoxon signed-rank test outlined that differences between all pre-and post-test scores were significant (P < .001). There was a marked improvement in the post-test as evidenced by statistically significant increases in mean scores differences. We developed an educational training courses for physicians to address the limitation in existing medical undergraduate training of neuropathic pain management. The training led to improvement in participant's knowledge and skills with positive outcomes.


Assuntos
Aprendizagem , Neuralgia , Humanos , Feminino , Masculino , Escolaridade , Pessoal de Saúde/educação , Neuralgia/diagnóstico , Neuralgia/terapia , Atenção Primária à Saúde
2.
Int J Mol Sci ; 23(21)2022 Oct 27.
Artigo em Inglês | MEDLINE | ID: mdl-36361821

RESUMO

Chronic neuropathic pain (CNP) affects around 10% of the general population and has a significant social, emotional, and economic impact. Current diagnosis techniques rely mainly on patient-reported outcomes and symptoms, which leads to significant diagnostic heterogeneity and subsequent challenges in management and assessment of outcomes. As such, it is necessary to review the approach to a pathology that occurs so frequently, with such burdensome and complex implications. Recent research has shown that imaging methods can detect subtle neuroplastic changes in the central and peripheral nervous system, which can be correlated with neuropathic symptoms and may serve as potential markers. The aim of this paper is to review available imaging methods used for diagnosing and assessing therapeutic efficacy in CNP for both the preclinical and clinical setting. Of course, further research is required to standardize and improve detection accuracy, but available data indicate that imaging is a valuable tool that can impact the management of CNP.


Assuntos
Neuralgia , Humanos , Neuralgia/diagnóstico por imagem , Neuralgia/terapia , Sistema Nervoso Periférico , Biomarcadores , Diagnóstico por Imagem
3.
Pain Physician ; 25(7): E1047-E1055, 2022 10.
Artigo em Inglês | MEDLINE | ID: mdl-36288590

RESUMO

BACKGROUND: Pulsed radiofrequency (PRF) is a commonly used, minimally invasive method to treat herpes zoster neuralgia, but the intensity of standard voltage PRF is limited, resulting in patients not getting a lasting therapeutic effect. The therapeutic effect of repeated high-voltage long-duration PRF on acute herpes zoster neuralgia has not been studied. OBJECTIVE: How to effectively reduce the incidence of postherpetic neuralgia is a serious challenge for clinicians. The purpose of this study was to investigate the clinical efficacy of repeated high-voltage long-duration pulsed radiofrequency therapy for patients with acute herpetic neuralgia and its preventive effect on postherpetic neuralgia. STUDY DESIGN: This is a retrospective study. SETTING: The study was carried out in the Pain Department of the affiliated Hospital of Jiaxing College in Jiaxing, China. METHODS: Eighty-one patients with acute herpetic neuralgia, who underwent minimally invasive treatment in the Pain Department of Jiaxing First Hospital from January 2020 through December 2020 were retrospectively analyzed. Patients were divided into 3 groups (n = 27 each group) according to treatment method: standard voltage PRF (group S); high-voltage long-duration PRF (group H), and repeated high-voltage long-duration PRF (group R). Pain was assessed according to Numeric Rating Scale (NRS-11) scores and analgesic drug doses were recorded. Blood galectin-3 (gal-3) and interleukin (IL)-6 levels among the 3 groups were compared before treatment and at one, 2, and 4 weeks posttreatment. The incidence of postherpetic neuralgia (PHN) and complications in the 3 groups were recorded. RESULTS: Pain intensity, blood levels of gal-3 and IL-6, and the dose of orally administered gabapentin capsules and morphine were reduced in all patients after treatment. Compared to group S, patients in group R exhibited lower NRS-11 scores, blood levels of gal-3 and IL-6, and dosages of oral gabapentin capsules after treatment. The incidence of PHN was significantly lower at weeks 4, 8, and 12. No adverse reactions occurred in the 3 groups posttreatment. LIMITATIONS: Our small sample size is a limitation; we look forward to increasing the sample size in follow-up studies and exploring relevant conclusions in randomized controlled trials. CONCLUSION: Repeated high-voltage long-duration PRF therapy was an effective treatment for acute herpetic neuralgia and may prevent the occurrence of PHN.


Assuntos
Herpes Zoster , Neuralgia Pós-Herpética , Neuralgia , Tratamento por Radiofrequência Pulsada , Humanos , Neuralgia Pós-Herpética/terapia , Tratamento por Radiofrequência Pulsada/métodos , Estudos Retrospectivos , Gabapentina , Galectina 3 , Interleucina-6 , Neuralgia/terapia , Herpes Zoster/terapia , Herpes Zoster/complicações , Derivados da Morfina
4.
Pain Physician ; 25(7): E1121-E1128, 2022 10.
Artigo em Inglês | MEDLINE | ID: mdl-36288599

RESUMO

BACKGROUND: Pulsed radiofrequency (PRF) is a percutaneous, micro-invasive, and micro-destructive neuromodulation technology. It has been reported to be useful in the treatment of supraorbital neuralgia (SN). However, the long-term effectiveness and safety of this technique in SN has not been reported yet. OBJECTIVES: To investigate the outcomes of PRF on supraorbital neuralgia (SN) in multi-centers and a long-term perspective. STUDY DESIGN: Retrospective case series. METHODS: Patients who underwent PRF for SN at 4 hospitals in Beijing between Jan 2007 and Jan 2021 were identified and reviewed for inclusion. Their demographic data and baseline conditions were statistically described, and their conditions of pain control were analyzed using Kaplan-Meier survival analyses. A survival curve was plotted, the cumulative proportion of pain-free at specific time points was determined, and the median pain-free time was estimated. Complications related to PRF treatment were summarized. The risk factors for initial pain control and pain-free survival were analyzed using logistic regression and Cox regression. RESULTS: A total of 116 patients were included; 91 (78.4%) patients got initial pain control with just one attempt of PRF. The maximum length of follow-up was 127 months, with a median of 18 months. During follow-up, 29 (31.9%) patients suffered from pain recurrence, and 11 (12.1%) were lost. The cumulative pain-free survival at 6 months, 1 year, 2 years, 3 years, 5 years, 8 years, and 10 years were estimated as 70%, 64%, 59%, 55%, 44%, 37%, and 37%, respectively. The median pain-free time was 52 months. No severe complications were observed or reported. Duration of disease could significantly influence initial pain control, while no risk factors for pain-free survival were recognized. LIMITATIONS: A retrospective study setting without a control group. CONCLUSION: The performance of PRF for the treatment of SN was confirmed to be favorable in a multicentric, relatively large scale, and long-term perspective.


Assuntos
Neuralgia , Tratamento por Radiofrequência Pulsada , Neuralgia do Trigêmeo , Humanos , Tratamento por Radiofrequência Pulsada/métodos , Estudos Retrospectivos , Neuralgia/terapia , Neuralgia do Trigêmeo/terapia , Manejo da Dor/métodos , Resultado do Tratamento
5.
Oper Neurosurg (Hagerstown) ; 23(6): e348-e352, 2022 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-36227247

RESUMO

BACKGROUND: Spinal cord stimulation (SCS) is a safe neuromodulatory treatment used to treat failed back surgery syndrome, chronic neuropathic pain, and complex regional pain syndrome. Despite its efficacy, some patients fail to achieve pain relief and elect to undergo removal of SCS paddle leads. The safety and best practices of these procedures have not been defined. OBJECTIVE: In this article, we describe our technique and complication rate in a series of SCS paddle removals. METHODS: All patients who underwent SCS paddle removal at the Albany Medical Center between 2011 and 2020 were identified. Medical charts were reviewed for demographic data, operative technique, and incidence of complications within 30 days of the procedure. RESULTS: Thirty-two (91%) patients underwent a thoracic paddle removal, whereas 3 (9%) underwent a cervical paddle removal. All cases underwent preoperative imaging with computed tomography or MRI, and all cases were performed with neuromonitoring and fluoroscopy. The technique required for paddle removal depended on the extent of local scar formation and ranged from soft tissue dissection to additional laminectomy at an adjacent level. Cases took on average 2 ± 0.09 hours with 23.21 ± 4.29 cc blood loss. Two patients had superficial infections, which were cleared with 1 week of oral antibiotics. There were no other adverse events. CONCLUSION: Thirty-five patients successfully underwent paddle removal with the minor complications reported. In this article, we show that by using neuromonitoring, fluoroscopy, and the techniques described, SCS paddle removal can be performed with minimal risk.


Assuntos
Síndromes da Dor Regional Complexa , Síndrome Pós-Laminectomia , Neuralgia , Estimulação da Medula Espinal , Humanos , Estimulação da Medula Espinal/métodos , Eletrodos Implantados/efeitos adversos , Síndrome Pós-Laminectomia/terapia , Síndrome Pós-Laminectomia/etiologia , Síndromes da Dor Regional Complexa/terapia , Neuralgia/terapia
6.
Neurosurg Focus ; 53(4): E13, 2022 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-36183181

RESUMO

OBJECTIVE: Neuropathic pain is undertreated in children. Neurosurgical treatments of pediatric chronic pain are limited by the absence of both US Food and Drug Administration approval and pediatric-specific hardware, as well as weak referral patterns due to a lack of physician education. This study presents a single-institution retrospective case series of spinal cord stimulation (SCS) in children ≤ 19 years of age and a systematic review of SCS in children. The authors' findings may further validate the role of SCS as an effective treatment modality for varied neuropathic pain syndromes found in pediatric patients. METHODS: The study was a single-center, single-surgeon, retrospective case series of individuals treated between July 2017 and May 2022. The outcomes for pediatric patients with chronic neuropathic pain syndromes indicated by the multidisciplinary pain clinic for evaluation for SCS were cataloged. A systematic review and individual participant data (IPD) meta-analysis was performed for cases treated until May 2022, using PubMed, EMBASE, and Scopus to characterize outcomes of children with neuropathic pain treated with SCS. RESULTS: Twelve patients were evaluated and 9 were indicated for percutaneous or buried lead trials. Seven female and 2 male patients between the ages of 13 and 19 years were implanted with trial leads. Eight of 9 (89%) patients went on to receive permanent systems. The average trial length was 6 days, and the length of stay for both trial and implant was less than 1 day. Complication rates due to CSF leaks were 22% and 0% for trial and implant, respectively. Visual analog scale pain scores decreased from 9.2 to 2.9 (p = 0.0002) and the number of medications decreased from 4.9 to 2.1 (p = 0.0005). Functional status also improved for each patient. A systematic review identified 13 studies describing pediatric patients with SCS, including 12 providing IPD on 30 patients. In the IPD meta-analysis, pain was reduced in 16/16 (100%) of patients following surgery and in 25/26 (96.2%) at last follow-up. Medication use was decreased in 16/21 (76.2%), and functional outcomes were improved in 29/29 (100%). The complication rate was 5/30 (16.7%). CONCLUSIONS: SCS effectively decreases pain and medication use for pediatric neuropathic pain syndromes. Patients also report improved functional status, including improved matriculation, gainful employment, and physical activity. There is minimal high-quality literature describing neuromodulation for pain in children. Neuromodulation should be considered earlier as a viable alternative to escalating use of multiple drugs and as a potential mechanism to address tolerance, dependence, and addiction in pediatric patients.


Assuntos
Dor Crônica , Neuralgia , Estimulação da Medula Espinal , Adolescente , Adulto , Criança , Dor Crônica/terapia , Feminino , Humanos , Masculino , Neuralgia/terapia , Estudos Retrospectivos , Medula Espinal , Síndrome , Resultado do Tratamento , Adulto Jovem
7.
Front Immunol ; 13: 999407, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36248896

RESUMO

Chronic pain remains to be a clinical challenge and is recognized as a major health problem with varying impacts on quality of life. Currently, the first-line therapy for chronic pain is opioids, which are often accompanied by unwanted psychoactive side effects. Thus, new and effective treatments for chronic pain are urgently needed and eagerly pursued. Inflammatory cytokines, especially interleukin-17 (IL-17), are reportedly potential therapeutic targets owing to their pivotal role in chronic pain from the neuroinflammation perspective. Recently, substantial evidence confirmed that IL-17 and IL-17 receptors (IL-17Rs) were increased in neuropathic, inflammatory, and cancer pain models. Notably, IL-17/IL-17R antibodies also reportedly relieve or cure inflammatory- and pain-related diseases. However, existing studies have reported controversial results regarding IL-17/IL-17Rs as potential therapeutic targets in diverse animal models of chronic pain. In this review, we present a summary of published studies and discuss the evidence, from basic to clinical to research, regarding the role and mechanism of action between IL-17 and diverse kinds of chronic pain in animal models and clinical patients. Furthermore, we evaluated IL-17-based therapy as a potential therapeutic strategy for inflammatory- and pain-related disease. Importantly, we also discussed clinical trials of IL-17/IL-17R targeting monoclonal antibodies. Overall, we found that IL-17 is a potential therapeutic target for chronic pain from the perspective of neuroinflammation.


Assuntos
Dor Crônica , Neuralgia , Analgésicos Opioides , Animais , Anticorpos Monoclonais , Dor Crônica/tratamento farmacológico , Citocinas , Interleucina-17 , Neuralgia/terapia , Qualidade de Vida , Receptores de Interleucina-17
9.
Cells ; 11(20)2022 Oct 20.
Artigo em Inglês | MEDLINE | ID: mdl-36291169

RESUMO

Neurostimulation-based therapeutic approaches are emerging as alternatives to pharmacological drugs, but need further development to optimize efficacy and reduce variability. Despite its key relevance to pain, the insular cortex has not been explored in cortical neurostimulation approaches. Here, we developed an approach to perform repetitive transcranial direct current stimulation of the posterior insula (PI tDCS) and studied its impact on sensory and aversive components of neuropathic pain and pain-related anxiety and the underlying neural circuitry in mice using behavioral methods, pharmacological interventions and the expression of the activity-induced gene product, Fos. We observed that repetitive PI tDCS strongly attenuates the development of neuropathic mechanical allodynia and also reverses chronically established mechanical and cold allodynia for several weeks post-treatment by employing descending opioidergic antinociceptive pathways. Pain-related anxiety, but not pain-related aversion, were inhibited by PI tDCS. These effects were associated with a long-term suppression in the activity of key areas involved in pain modulation, such as the cingulate, prefrontal and motor cortices. These data uncover the significant potential of targeting the insular cortex with the objective of pain relief and open the way for more detailed mechanistic analyses that will contribute to improving cortical neurostimulation therapies for use in the clinical management of pain.


Assuntos
Córtex Motor , Neuralgia , Estimulação Transcraniana por Corrente Contínua , Animais , Camundongos , Neuralgia/terapia , Manejo da Dor/métodos , Analgésicos
10.
J Neural Eng ; 19(5)2022 Oct 31.
Artigo em Inglês | MEDLINE | ID: mdl-36228593

RESUMO

Objective. Spinal cord injury (SCI) often results in debilitating movement impairments and neuropathic pain. Electrical stimulation of spinal neurons holds considerable promise both for enhancing neural transmission in weakened motor pathways and for reducing neural transmission in overactive nociceptive pathways. However, spinal stimulation paradigms currently under development for individuals living with SCI continue overwhelmingly to be developed in the context of motor rehabilitation alone. The objective of this study is to test the hypothesis that motor-targeted spinal stimulation simultaneously modulates spinal nociceptive transmission.Approach. We characterized the neuromodulatory actions of motor-targeted intraspinal microstimulation (ISMS) on the firing dynamics of large populations of discrete nociceptive specific and wide dynamic range (WDR) neurons. Neurons were accessed via dense microelectrode arrays implantedin vivointo lumbar enlargement of rats. Nociceptive and non-nociceptive cutaneous transmission was induced before, during, and after ISMS by mechanically probing the L5 dermatome.Main results. Our primary findings are that (a) sub-motor threshold ISMS delivered to spinal motor pools immediately modulates concurrent nociceptive transmission; (b) the magnitude of anti-nociceptive effects increases with longer durations of ISMS, including robust carryover effects; (c) the majority of all identified nociceptive-specific and WDR neurons exhibit firing rate reductions after only 10 min of ISMS; and (d) ISMS does not increase spinal responsiveness to non-nociceptive cutaneous transmission. These results lead to the conclusion that ISMS parameterized to enhance motor output results in an overall net decrease n spinal nociceptive transmission.Significance. These results suggest that ISMS may hold translational potential for neuropathic pain-related applications and that it may be uniquely suited to delivering multi-modal therapeutic benefits for individuals living with SCI.


Assuntos
Neuralgia , Traumatismos da Medula Espinal , Estimulação da Medula Espinal , Ratos , Animais , Medula Espinal/fisiologia , Traumatismos da Medula Espinal/reabilitação , Estimulação da Medula Espinal/métodos , Estimulação Elétrica/métodos , Neuralgia/terapia
11.
Int J Mol Sci ; 23(19)2022 Oct 09.
Artigo em Inglês | MEDLINE | ID: mdl-36233275

RESUMO

This study investigated the hypothesis that probiotics enhanced the therapeutic effect of adipose-derived mesenchymal stem cells (ADMSCs) on alleviating neuropathic pain (NP) due to chronic constriction injury (CCI) mainly through regulating the microbiota in rats. SD rats (n = 50) were categorized into group 1 (sham-control), group 2 (NP), group 3 (NP + probiotics (i.e., 1.5 billion C.F.U./day/rat, orally 3 h after NP procedure, followed by QOD 30 times)), group 4 (NP + ADMSCs (3.0 × 105 cells) 3 h after CCI procedure, followed by QOD six times (i.e., seven times in total, i.e., mimic a clinical setting of drug use) and group 5 (NP + probiotics + ADMSCs (3.0 × 105 cells)) and euthanized by day 60 after NP induction. By day 28 after NP induction, flow-cytometric analysis showed circulating levels of early (AN-V+/PI-) and late (AN-V+/PI+) apoptotic, and three inflammatory (CD11b-c+, Ly6G+ and MPO+) cells were lowest in group 1 and significantly progressively reduced in groups 2 to 5 (all p < 0.0001). By days 7, 14, 21, 28, and 60 after CCI, the thresholds of thermal paw withdrawal latency (PWL) and mechanical paw withdrawal threshold (PWT) were highest in group 1 and significantly progressively increased in groups 2 to 5 (all p < 0.0001). Numbers of pain-connived cells (Nav1.8+/peripherin+, p-ERK+/peripherin+, p-p38+/peripherin+ and p-p38+/NF200+) and protein expressions of inflammatory (p-NF-κB, IL-1ß, TNF-α and MMP-9), apoptotic (cleaved-caspase-3, cleaved-PARP), oxidative-stress (NOX-1, NOX-2), DNA-damaged (γ-H2AX) and MAPK-family (p-P38, p-JNK, p-ERK1/2) biomarkers as well as the protein levels of Nav.1.3, Nav.1.8, and Nav.1.9 in L4-L5 in dorsal root ganglia displayed an opposite pattern of mechanical PWT among the groups (all p < 0.0001). In conclusion, combined probiotic and ADMSC therapy was superior to merely one for alleviating CCI-induced NP mainly through suppressing inflammation and oxidative stress.


Assuntos
Células-Tronco Mesenquimais , Neuralgia , Probióticos , Animais , Biomarcadores/metabolismo , Caspase 3/metabolismo , DNA/metabolismo , Inflamação/metabolismo , Metaloproteinase 9 da Matriz/metabolismo , Células-Tronco Mesenquimais/metabolismo , NF-kappa B/metabolismo , Neuralgia/tratamento farmacológico , Neuralgia/terapia , Periferinas/metabolismo , Inibidores de Poli(ADP-Ribose) Polimerases/uso terapêutico , Probióticos/farmacologia , Probióticos/uso terapêutico , Ratos , Ratos Sprague-Dawley , Roedores/metabolismo , Fator de Necrose Tumoral alfa/metabolismo
12.
Zhongguo Zhen Jiu ; 42(9): 1029-36, 2022 Sep 12.
Artigo em Chinês | MEDLINE | ID: mdl-36075600

RESUMO

OBJECTIVE: To observe the effect of electroacupuncture (EA) at "Huantiao" (GB 30) and "Weizhong" (BL 40) on the activation of glial cells, the expression of brain-derived neurotrophic factor (BDNF), excitability and the number of dendritic spines of neurons in the spinal dorsal horn in rats with spared nerve injury (SNI) of sciatic nerve, and to explore the analgesic mechanism of EA on SNI. METHODS: PartⅠ: Sixty SD rats were randomly divided into a sham operation group, a model group, an EA group and a sham EA group, 15 rats in each group. Except the sham operation group, the SNI rat model was established in the remaining groups. The rats in the sham operation group were only treated with incision without damaging the nerve. The rats in the EA group were treated with EA at "Huantiao" (GB 30) and "Weizhong" (BL 40) on the affected side, continuous wave, frequency of 2 Hz, current intensity of 1 mA, 30 minutes each time, once a day, for 14 days. The rats in the sham EA group were treated with EA at points 0.5 cm next to "Huantiao" (GB 30) and "Weizhong" (BL 40) on the affected side; the manipulation, EA parameters and treatment course were the same as the EA group. The latency of thermal foot contraction reflex and the threshold of mechanical foot contraction reflex were detected 1 day before modeling and 3, 7 and 14 days after modeling. Fourteen days after modeling, Western blot was used to detect the protein expressions of ionized binding adapter junction protein 1 (Iba-1), glial fibrillary acidic protein (GFAP), BDNF and c-Fos in the spinal dorsal horn; the expressions of Iba-1 and c-Fos proteins in the spinal dorsal horn were detected by immunofluorescence staining; immunohistochemical method was used to detect the expression of GFAP protein in the spinal dorsal horn; Golgi staining was used to detect the number of dendritic spines in spinal dorsal horn neurons. PartⅡ: Thirty SD rats were randomly divided into a control group, a BDNF group and a BDNF+anti-TrkB group, 10 rats in each group. The control group was treated with intrathecal injection of 10 µL mixture with 1︰1 of 0.9% sodium chloride solution and dimethyl sulfoxide (DMSO); the BDNF group was treated with intrathecal injection of 10 µg rat recombinant BDNF dissolved in 10 µL mixture with 1︰1 of 0.9% sodium chloride solution and DMSO; the BDNF+anti-TrkB group was treated with intrathecal injection of 10 µg rat recombinant BDNF and 30 µg tyrosine kinase receptor B (TrkB) antibody dissolved in 10 µL mixture with 1︰1 of 0.9% sodium chloride solution and DMSO. The threshold of mechanical foot retraction reflex was detected 1 day before intrathecal injection and 1, 3 and 7 days after injection. Seven days after injection, the expression of c-Fos protein in the spinal dorsal horn was detected by Western blot and immunofluorescence staining. RESULTS: PartⅠ: Compared with the sham operation group, 3, 7 and 14 days after modeling, the latency of thermal foot contraction reflex and the threshold of mechanical foot contraction reflex in the model group were decreased (P<0.05); 7 and 14 days after modeling, compared with the model group, the latency of thermal foot contraction reflex and the threshold of mechanical foot contraction reflex in the EA group were increased (P<0.05). The expressions of Iba-1, GFAP, BDNF, c-Fos proteins and the number of neuronal dendritic spines in the spinal dorsal horn in the model group were higher than those in the sham operation group (P<0.05); the expressions of Iba-1, BDNF, c-Fos proteins and the number of neuronal dendritic spines in the EA group were lower than those in the model group (P<0.05). PartⅡ: 3 and 7 days after intrathecal injection, the threshold of mechanical foot retraction reflex in the BDNF group was lower than that in the control group (P<0.05); the threshold of mechanical foot retraction reflex in the BDNF+anti-TrkB group was higher than that in the BDNF group (P<0.05). The expression of c-Fos protein in spinal dorsal horn in the BDNF group was higher than that in the control group (P<0.05); the expression of c-Fos protein in spinal dorsal horn in the BDNF+anti-TrkB group was lower than that in the BDNF group (P<0.05). CONCLUSION: The analgesic effect of EA at "Huantiao" (GB 30) and "Weizhong" (BL 40) on SNI rats may be related to inhibiting the activation of microglia in the dorsal horn of the spinal cord, thereby blocking the signal of microglia-BDNF-neuron, and finally reducing the excitability of neurons.


Assuntos
Eletroacupuntura , Neuralgia , Analgésicos , Animais , Fator Neurotrófico Derivado do Encéfalo/genética , Fator Neurotrófico Derivado do Encéfalo/metabolismo , Dimetil Sulfóxido/metabolismo , Microglia , Neuralgia/terapia , Neurônios , Proteínas Proto-Oncogênicas c-fos/metabolismo , Ratos , Ratos Sprague-Dawley , Cloreto de Sódio/metabolismo , Medula Espinal/metabolismo
13.
Clin J Pain ; 38(11): 686-692, 2022 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-36173138

RESUMO

OBJECTIVE: This study aimed to investigate the effect of therapy with peripheral nerve stimulation (PNS) and pulsed radiofrequency (PRF) combined or PNS and PRF separately in patients with herpes zoster ophthalmicus (HZO). MATERIALS AND METHODS: This cohort study included 106 cases of HZO. Three groups were identified according to the type of treatment received: combination therapy (PNS+PRF) (n=38), PRF (n=37), and PNS (n=31). The observations at 0, 1, 2, and 4 weeks; 3 and 6 months; and 1 and 2 years after the operation were analyzed. Observations at each follow-up included baseline characteristics, Numerical Rating Scale (NRS) and the Pittsburgh Sleep Quality Index (PSQI), concomitant pain medication usage, relapse rate, and adverse events. RESULTS: The postoperative NRS of all 3 groups were significantly lower than preoperative scores. The PSQI of the 3 groups was significantly improved postoperatively, and the concomitant pain medication gradually decreased. Regarding long-term efficacy, the pain NRS and PSQI scores of the PNS+PRF and PNS groups were significantly lower than those of the PRF group ( P <0.05), and the relapse rate of the PRF group was higher than that of the PNS+PRF and PNS groups ( P <0.05). No significant difference was observed between the PNS+PRF and the PNS groups. CONCLUSION: Both PNS and PRF treatment of HZO can decrease the pain score, yielding no serious complications. The combination of PNS and PRF or PNS alone resulted in more significant pain relief than treatment with PRF alone. Thus, PNS therapy may be a better treatment option for HZO.


Assuntos
Herpes Zoster Oftálmico , Herpes Zoster , Neuralgia , Tratamento por Radiofrequência Pulsada , Estudos de Coortes , Herpes Zoster/complicações , Herpes Zoster Oftálmico/complicações , Herpes Zoster Oftálmico/terapia , Humanos , Neuralgia/complicações , Neuralgia/terapia , Nervos Periféricos , Tratamento por Radiofrequência Pulsada/métodos , Recidiva , Resultado do Tratamento
14.
Neural Plast ; 2022: 7670629, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36160326

RESUMO

Electroacupuncture (EA) therapy has been widely reported to alleviate neuropathic pain with few side effects in both clinical practice and animal studies worldwide. However, little is known about the comparison of the therapeutic efficacy among the diverse EA schemes used for neuropathic pain. The present study is aimed at investigating the therapeutic efficacy discrepancy between the single and combined-acupoint EA and to reveal the difference of mechanisms behind them. Electroacupuncture was given at both Zusanli (ST36) and Huantiao (GB30) in the combined group or ST36 alone in the single group. Paw withdrawal mechanical threshold (PWMT) was measured to determine the pain level. Electrophysiology was performed to detect the effects of EA on synaptic transmission in the spinal dorsal horn of the vGlut2-tdTomato mice. Spinal contents of endogenous opioids, endocannabinoids, and their receptors were examined. Inhibitors of CBR (cannabinoid receptor) and opioid receptors were used to study the roles of opioid and endocannabinoid system (ECS) in EA analgesia. We found that combined-acupoint acupuncture provide stronger analgesia than the single group did, and the former inhibited the synaptic transmission at the spinal level to a greater extent than later. Besides, the high-intensity stimulation at ST36 or normal stimulation at two sham acupoints did not mimic the similar efficacy of analgesia in the combined group. Acupuncture stimulation in single and combined groups both activated the endogenous opioid system. The ECS was only activated in the combined group. Naloxone totally blocked the analgesic effect of single-acupoint EA; however, it did not attenuate that of combined-acupoint EA unless coadministered with CBR antagonists. Hence, in the CCI-induced neuropathic pain model, combined-acupoint EA at ST36 and GB30 is more effective in analgesia than the single-acupoint EA at ST36. EA stimulation at GB30 alone neither provided a superior analgesic effect to EA treatment at ST36 nor altered the content of AEA, 2-AG, CB1 receptor, or CB2 receptor compared with the CCI group. Activation of the ECS is the main contributor of the better analgesia by the combined acupoint stimulation than that induced by single acupoint stimulation.


Assuntos
Eletroacupuntura , Neuralgia , Pontos de Acupuntura , Analgésicos Opioides , Animais , Endocanabinoides , Camundongos , Naloxona , Neuralgia/terapia , Receptor CB1 de Canabinoide , Receptor CB2 de Canabinoide , Receptores Opioides , Medula Espinal , Corno Dorsal da Medula Espinal
15.
Rev Neurol ; 75(6): 149-157, 2022 09 16.
Artigo em Espanhol | MEDLINE | ID: mdl-36098449

RESUMO

INTRODUCTION: Despite the evolution of surgical techniques, pain continues to be one of the most frequent disorders in the postoperative period of cardiac surgery (CS), leading to the appearance of complications in the acute period and impairment of quality of life due to the appearance of chronic pain. In this narrative review, we aim to analyze the prognostic factors for the appearance of postoperative pain after CS, to locate and quantify the severity of neuropathic pain, and determine the most appropriate assessment methods in these patients. DEVELOPMENT: Postoperative pain in CS is a complex pain, which associates neuropathic, somatic and visceral components. Its origin is multifactorial; factors depending on the patient, the preoperative symptoms and the type of intervention, as well as sequelae derived from the surgery itself, determine the variability in its manifestation. Multiple studies have tried to identify the risk factors for its development, but the quantification of pain is limited by the subjective perception of the patients. CONCLUSIONS: Neurologists can play a relevant role in the differentiation of the different types of pain after CS, thanks to the understanding of its neurobiological bases, properly handling neuromodulators that control the neuropathic component of pain and collaborating in the indication of invasive techniques, necessary occasionally in the management of these patients.


TITLE: Dolor en el postoperatorio de cirugía cardíaca: bases neurobiológicas y tratamiento.Introducción. A pesar de la evolución de las técnicas quirúrgicas, el dolor sigue siendo uno de los trastornos más frecuentes en el postoperatorio de la cirugía cardíaca (CCA), lo que condiciona la aparición de complicaciones en la fase aguda y el deterioro de la calidad de vida por la aparición de dolor crónico. En esta revisión narrativa pretendemos analizar los factores pronósticos de la aparición de dolor postoperatorio tras CCA, localizar y cuantificar la gravedad del dolor neuropático y determinar cuáles son los métodos de evaluación más adecuados en estos pacientes. Desarrollo. El dolor postoperatorio en la CCA es un dolor complejo, que asocia componentes neuropáticos, somáticos y viscerales. Su origen es multifactorial; factores dependientes del paciente, de la clínica preoperatoria y el tipo de intervención, así como de secuelas derivadas de la propia cirugía, determinan la variabilidad en su manifestación. Múltiples estudios han intentado identificar los factores de riesgo de su desarrollo, pero la cuantificación del dolor se ve limitada por la percepción subjetiva del paciente. Conclusiones. Los neurólogos pueden tener un papel relevante en la diferenciación de los distintos tipos de dolor tras CCA, gracias a la comprensión de sus bases neurobiológicas, manejando adecuadamente neuromoduladores que controlen el componente neuropático del dolor y colaborando en la indicación de técnicas invasivas, necesarias ocasionalmente en el manejo de estos pacientes.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Dor Crônica , Neuralgia , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Humanos , Neuralgia/etiologia , Neuralgia/terapia , Dor Pós-Operatória/etiologia , Dor Pós-Operatória/terapia , Qualidade de Vida
16.
Pain Manag ; 12(7): 805-811, 2022 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-36106625

RESUMO

We present a case of a 53-year-old male who presented with functionally limiting bilateral lower extremity neuropathic pain secondary to multiple subtypes of small fiber neuropathy. He had failed management with multiple conservative measures including oral medications, physical therapy and desensitization techniques. He ultimately underwent placement of a spinal cord stimulator and continued to experience 80% improvement of his pain, as well as improved function and quality of life at 5 month follow-up. To our knowledge, this is the first reported case of successful treatment of multiple subtypes of small fiber neuropathy with spinal cord stimulator.


We report a case of a 53-year-old male who presented with multiple subtypes of small fiber neuropathy, characterized by abnormal sensation and nerve pain in his distal lower extremities, which was making performing his activities of daily living challenging. He had failed multiple conservative measures including oral medications, physical therapy and desensitization techniques. The patient then underwent a trial with a spinal cord stimulator, which includes placing a device in the spinal canal that can alleviate pain by providing low levels of electrical current. At the 5 month follow-up, he continued to report 80% improvement of his pain as well as improved function and quality of life. This is the first reported use of spinal cord stimulator in a patient with multiple subtypes of small fiber neuropathy.


Assuntos
Antineoplásicos , Infecções por HIV , Neuralgia , Polineuropatias , Neuropatia de Pequenas Fibras , Estimulação da Medula Espinal , Infecções por HIV/complicações , Infecções por HIV/tratamento farmacológico , Humanos , Masculino , Pessoa de Meia-Idade , Neuralgia/induzido quimicamente , Neuralgia/complicações , Neuralgia/terapia , Polineuropatias/induzido quimicamente , Polineuropatias/complicações , Polineuropatias/terapia , Qualidade de Vida , Neuropatia de Pequenas Fibras/complicações , Medula Espinal , Estimulação da Medula Espinal/métodos
17.
Spinal Cord Ser Cases ; 8(1): 80, 2022 09 15.
Artigo em Inglês | MEDLINE | ID: mdl-36109507

RESUMO

INTRODUCTION: Neuropathic pain is a common complication of spinal cord injury (SCI), and is notoriously difficult to adequately treat. Gunshot wounds (GSW) near the spinal cord may cause intractable chronic pain through spinal/nerve root transection, or reactive tissue formation resulting in nerve root compression from retained bullet fragments (RBF). CASE PRESENTATION: This case report describes a 30-year-old man with a T12 AIS B incomplete spinal cord injury with paraplegia secondary to multiple GSW who presented with severe bilateral lower extremity dysesthesias and muscle spasms. Symptoms failed to improve with oral antispasmodic medications. After being diagnosed with Complex regional pain syndrome (CRPS) type I secondary to an SCI via GSW, he underwent a spinal cord stimulator (SCS) trial, which improved his symptoms by greater than 80%. DISCUSSION: Neuropathic pain refractory to conservative treatment may benefit from SCS. Effects of therapy go beyond gate-theory in SCI patients, and may benefit patients at the cellular and molecular level. Our case demonstrates the effectiveness of SCS treatment in a patient who developed CRPS type 1 after GSW resulting in SCI.


Assuntos
Síndromes da Dor Regional Complexa , Neuralgia , Traumatismos da Medula Espinal , Estimulação da Medula Espinal , Ferimentos por Arma de Fogo , Adulto , Síndromes da Dor Regional Complexa/complicações , Síndromes da Dor Regional Complexa/terapia , Humanos , Masculino , Neuralgia/etiologia , Neuralgia/terapia , Parassimpatolíticos , Traumatismos da Medula Espinal/complicações , Traumatismos da Medula Espinal/terapia , Estimulação da Medula Espinal/efeitos adversos , Estimulação da Medula Espinal/métodos , Ferimentos por Arma de Fogo/complicações , Ferimentos por Arma de Fogo/terapia
18.
Pain Res Manag ; 2022: 4323045, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36071945

RESUMO

Pain sensitization and neuropathic pain-like symptoms are some of the common pain symptoms in patients with lower limbs, including hip and knee, osteoarthritis (HOA/KOA). Exercise therapy has been the first-line treatment; however, the effects differ for each patient. This prospective cohort study investigated the relationship between the effectiveness of exercise therapy and pretreatment characteristics (radiologic severity, pain sensitization, and neuropathic pain-like symptoms) of patients with HOA/KOA. We assessed the pain intensity using a numerical rating scale (NRS) before and after 12 weeks of exercise therapy in patients with HOA/KOA (n = 101). Before treatment, the Kellgren-Lawrence (K-L) grade; minimum joint space width (mJSW); pressure pain threshold (PPT) and temporal summation of pain (TSP) at the affected joint, tibia, and forearm; Central Sensitization Inventory-9; and painDETECT questionnaire (PDQ) were assessed. Cluster analysis was based on the pretreatment NRS and change in NRS with exercise therapy to identify the subgroups of pain reduction. The pretreatment characteristics of each cluster were compared. According to the results of the cluster analyses, patients in cluster 1 had severe pain that did not improve after exercise therapy, patients in cluster 2 had severe pain that improved, and those in cluster 3 had mild pain that improved. The patients in cluster 1 exhibited lower PPT at all measurement sites, higher TSP at the affected joint, and higher PDQ scores than those in other clusters. There was no difference in the K-L grade and mJSW among the clusters. The subgroup with severe pain and pain sensitization or neuropathic pain-like symptoms at pretreatment, even with mild joint deformity, may have difficulty in achieving improvement in pain after 12 weeks of exercise therapy. These findings could be useful for prognosis prediction and for planning exercise therapy and combining with other treatment.


Assuntos
Neuralgia , Osteoartrite do Quadril , Osteoartrite do Joelho , Terapia por Exercício , Humanos , Joelho , Neuralgia/complicações , Neuralgia/terapia , Osteoartrite do Quadril/complicações , Osteoartrite do Quadril/terapia , Osteoartrite do Joelho/complicações , Osteoartrite do Joelho/terapia , Estudos Prospectivos
19.
Neural Plast ; 2022: 6131696, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36061584

RESUMO

Background: Repetitive transcranial magnetic stimulation (rTMS) has been widely used in the treatment of neuropathic orofacial pain (NOP). The consistency of its therapeutic efficacy with the optimal protocol is highly debatable. Objective: To assess the effectiveness of rTMS on pain intensity, psychological conditions, and quality of life (QOL) in individuals with NOP based on randomized controlled trials (RCTs). Methods: We carefully screened and browsed 5 medical databases from inception to January 1, 2022. The study will be included that use of rTMS as the intervention for patients with NOP. Two researchers independently completed record retrieval, data processing, and evaluation of methodological quality. Quality and evidence were assessed using the PEDro scores and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system. Results: Six RCTs with 214 participants were included in this systematic review: 2 studies were considered level 1 evidence, and 4 were considered level 2 evidence. Six studies found that high-frequency rTMS had a pain-relieving effect, while 4 studies found no improvement in psychological conditions and QOL. Quality of evidence (GRADE system) ranged from moderate to high. No significant side effects were found. Conclusions: There is moderate-to-high evidence to prove that high-frequency rTMS is effective in reducing pain in individuals with NOP, but it has no significant positive effect on psychological conditions and QOL. High-frequency rTMS can be used as an alternative treatment for pain in individuals with NOP, but further studies will be conducted to unify treatment parameters, and the sample size will be expanded to explore its influence on psychological conditions and QOL.


Assuntos
Neuralgia , Estimulação Magnética Transcraniana , Dor Facial/etiologia , Dor Facial/terapia , Humanos , Neuralgia/etiologia , Neuralgia/terapia , Medição da Dor , Ensaios Clínicos Controlados Aleatórios como Assunto , Estimulação Magnética Transcraniana/métodos , Resultado do Tratamento
20.
Neurologia (Engl Ed) ; 37(7): 586-595, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-36064287

RESUMO

INTRODUCTION: The gate control theory of pain was the starting point of the development of spinal cord stimulation (SCS). We describe the indications for the treatment in pain management and other uses not related to pain. DEVELOPMENT: There are currently several paradigms for SCS: tonic, burst, and high frequency. The main difference lies in the presence of paraesthesias. SCS is most beneficial for treating neuropathic pain. Patients with failed back surgery syndrome show the best response rates, although a considerable reduction in pain is also observed in patients with complex regional pain syndrome, diabetic neuropathy, radiculopathy, and low back pain without previous surgery. Phantom pain or pain related to cardiovascular or peripheral vascular disease may improve, although there is a lack of robust evidence supporting generalisation of its use. SCS also improves cancer-related pain, although research on this issue is scarce. Non-pain-related indications for SCS are movement disorders, spasticity, and sequelae of spinal cord injury. The main limiting factors for the use of SCS are mechanical complications and the cost of the treatment. CONCLUSION: In its 50-year history, SCS has progressed enormously. The perfection of hardware and software may improve its effectiveness and reduce the rate of complications. Indications for SCS could include other diseases, and its use could be expanded, if the costs of the technology are reduced.


Assuntos
Neuropatias Diabéticas , Neuralgia , Estimulação da Medula Espinal , Humanos , Neuralgia/terapia , Manejo da Dor
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