Pain
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Patients with the same neuropathic pain disorder may have completely different sensory signs and symptoms yet receive the same medicinal treatment. New concepts suggest that patient stratification according to their pain mechanisms, reflected in their sensory phenotype, could be promising to implement an individualized therapy in neuropathic pain. ⋯ Recent prospective studies using stratification based on sensory phenotypes confirm this concept. In this article, we review the recent accomplishments towards an individualized pharmacological treatment of neuropathic pain.
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There is little information on the impact of pain on sexual health in later life. The aim of this analysis was to determine the association between self-reported pain and sexual health in older men and women. Data were collected for the nationally representative English Longitudinal Study of Ageing. ⋯ After age adjustment, there were no associations between pain severity and sexual health among women. Of the 1872 participants with a cumulative pain score, there were significant associations between reporting pain and concerns about sexual health in both men and women. Pain was associated with impairment in sexual health in men and women; however, the effect was more marked in men.
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With less than 50% of patients responding to the current standard of care and poor efficacy and selectivity of current treatments, neuropathic pain continues to be an area of considerable unmet medical need. Biological therapeutics such as monoclonal antibodies (mAbs) provide better intrinsic selectivity; however, delivery to the central nervous system (CNS) remains a challenge. Granulocyte-macrophage colony-stimulating factor (GM-CSF) is well described in inflammation-induced pain, and early-phase clinical trials evaluating its antagonism have exemplified its importance as a peripheral pain target. ⋯ Functional analysis of glial cells revealed that pretreatment with GM-CSF potentiated lipopolysaccharide-induced release of proinflammatory cytokines. In summary, our data indicate that GM-CSF is a proinflammatory cytokine that contributes to nociceptive signalling through driving spinal glial cell secretion of proinflammatory mediators. In addition, we report a successful approach to accessing CNS pain targets, providing promise for central compartment delivery of analgesics.