Journal of neuroimmune pharmacology : the official journal of the Society on NeuroImmune Pharmacology
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J Neuroimmune Pharmacol · Jun 2013
ReviewNeuroinflammation, neuroautoimmunity, and the co-morbidities of complex regional pain syndrome.
Complex Regional Pain Syndrome (CRPS) is associated with non-dermatomal patterns of pain, unusual movement disorders, and somatovisceral dysfunctions. These symptoms are viewed by some neurologists and psychiatrists as being psychogenic in origin. ⋯ From both animal and human studies, evidence is accumulating that neuroinflammation can spread, either anterograde or retrograde, via axonal projections in the CNS, thereby establishing neuroinflammatory tracks and secondary neuroinflammatory foci within the neuraxis. These findings suggest that neuroinflammatory lesions, as well as their associated functional consequences, should be evaluated during the differential diagnosis of non-dermatomal pain presentations, atypical movement disorders, as well as other "medically unexplained symptoms", which are often attributed to psychogenic illness.
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J Neuroimmune Pharmacol · Jun 2013
ReviewMeasuring GABAergic inhibitory activity with TMS-EEG and its potential clinical application for chronic pain.
Chronic pain is debilitating disorder in which the underlying pathophysiology is still unknown. Impaired cortical inhibition is one mechanism that is associated with chronic pain. Cortical inhibition refers to a neurophysiological process in which gamma-aminobutyric acid (GABA) inhibitory interneurons selectively attenuate the activity of pyramidal neurons in the cortex. ⋯ We then demonstrate TMS-EEG as a reliable method in which to record cortical inhibition directly from the prefrontal cortex to examine the modulatory effect of GABAB receptor inhibition on cortical oscillations. Finally, the modulation of GABA and gamma oscillations with repetitive TMS will be suggested as the possible mechanism through which rTMS exerts its therapeutic effects in the treatment of pain. The aim of this paper, therefore, is to present the TMS-EEG as a potential method through which to better classify, diagnose and treat chronic pain.
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J Neuroimmune Pharmacol · Jun 2013
ReviewImaging and clinical evidence of sensorimotor problems in CRPS: utilizing novel treatment approaches.
Inflammation and altered autonomic function are diagnostic signs and symptoms of Complex Regional Pain Syndrome. In the acute stages these are commonly at their most florid accompanied by severe pain and reduced function. Understandably this has directed research towards potential peripheral drivers for the causal mechanisms of this condition. ⋯ This increased knowledge around the peripheral and central mechanisms that may be operating in CRPS has been used to inform novel therapeutic approaches. We discuss here the presenting signs and symptoms of CRPS, with particular focus on sensory and motor changes and consider which mechanisms may drive these changes. Finally, we consider the emerging therapeutic options designed to correct these aberrant mechanisms.
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J Neuroimmune Pharmacol · Jun 2013
ReviewInflaming the brain: CRPS a model disease to understand neuroimmune interactions in chronic pain.
We review current concepts in CRPS from a neuroimaging perspective and point out topics and potential mechanisms that are suitable to be investigated in the next step towards understanding the pathophysiology of CRPS. We have outlined functional aspects of the syndrome, from initiating lesion via inflammatory mechanisms to CNS change and associated sickness behavior, with current evidence for up-regulation of immunological factors in CRPS, neuroimaging of systemic inflammation, and neuroimaging findings in CRPS. ⋯ Potential avenues for investigating CRPS with PET and fMRI are described, along with roles of inflammation, treatment and behavior in CRPS. It is our hope that this outline will provoke discussion and promote further empirical studies on the interactions between central and peripheral inflammatory pathways manifest in CRPS.
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J Neuroimmune Pharmacol · Jun 2013
Review Case ReportsMaking connections: using telehealth to improve the diagnosis and treatment of Complex Regional Pain Syndrome, an underrecognized neuroinflammatory disorder.
Complex Regional Pain Syndrome (CRPS) is a common and complex, but often underrecognized neuroinflammatory disorder. This syndrome can cause significant intractable pain, worsening motor changes, negative sensory symptoms as well as autonomic, vasomotor and trophic changes. Primary care providers and specialists are frequently challenged with patients who present with unusual symptoms and are unsure of the differential diagnosis and best practices treatment options for CRPS. The Project ECHO Pain Team leverages tele-health technologies to connect clinician specialists and primary care providers in order to increase awareness and create knowledge networks regarding improvement in clinical care for patients with CRPS.