Journal of neuroimmune pharmacology : the official journal of the Society on NeuroImmune Pharmacology
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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.
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J Neuroimmune Pharmacol · Jun 2013
EditorialImaging biomarkers and the role of neuroinflammation in neuropathic pain.
The papers from this thematic issue followed a translational research workshop, Imaging Neuroinflammation and Neuropathic Pain, that focused on the search for neuroimaging biomarkers to assess neuroinflammation associated with neuropathic pain. The topics covered in this issue include overviews of the historical and current knowledge regarding neuropathic pain, the potential mechanisms involved, the often under-recognized clinical presentations that can delay diagnosis, the various neuroimaging techniques that have been applied to evaluate neuropathic pain and neuroinflammation, to case series illustrating novel treatments of neuropathic pain. Furthermore, the use of telemedicine to disseminate knowledge and improve the diagnosis and treatment of pain syndromes is also discussed.
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J Neuroimmune Pharmacol · Jun 2013
Case ReportsTreatment of Complex Regional Pain Syndrome (CRPS) using low dose naltrexone (LDN).
Complex Regional Pain Syndrome (CRPS) is a neuropathic pain syndrome, which involves glial activation and central sensitization in the central nervous system. Here, we describe positive outcomes of two CRPS patients, after they were treated with low-dose naltrexone (a glial attenuator), in combination with other CRPS therapies. Prominent CRPS symptoms remitted in these two patients, including dystonic spasms and fixed dystonia (respectively), following treatment with low-dose naltrexone (LDN). LDN, which is known to antagonize the Toll-like Receptor 4 pathway and attenuate activated microglia, was utilized in these patients after conventional CRPS pharmacotherapy failed to suppress their recalcitrant CRPS symptoms.