Pain
-
Review Historical Article
Palliative care: Where have we come from and where are we going?
-
Tibia fracture in rats evokes nociceptive, vascular, and bone changes resembling complex regional pain syndrome (CRPS). Substance P (SP) signaling contributes to the hindpaw warmth, increased vascular permeability, and edema observed in this model, suggesting that neurogenic inflammatory responses could be enhanced after fracture. Four weeks after tibia fracture we measured SP and calcitonin gene-related peptide (CGRP) protein levels in the sciatic nerve and serum. ⋯ Fracture also increased epidermal thickness, but had no effect on epidermal skin neurite counts. These results demonstrate that spontaneous and intravenous SP-evoked extravasation responses are enhanced in the ipsilateral hindlimb after fracture and that fracture chronically increases the expression of endothelial and keratinocyte NK1 receptors in the injured limb. We postulate that SP activation of these up-regulated NK1 receptors results in skin warmth, protein leakage, edema, and keratinocyte proliferation in the injured limb.
-
Comparative Study
Comparison of skin incision vs. skin plus deep tissue incision on ongoing pain and spontaneous activity in dorsal horn neurons.
Surgery injures both skin and deep tissue causing pain at rest and evoked pain with activities. In this study, we examined the extent of injury by incision and dorsal horn neuron (DHN) spontaneous activity (SA) in rats that underwent a sham operation, skin incision or skin plus deep tissue incision. Pain behaviors were measured 1 day later followed by DHN recordings in the same rats. ⋯ In a separate group of rats that underwent skin plus deep tissue incision, guarding pain was not present (0.1+/-0.6) on POD7 and the percentage and rate of DHN SA were the same as in the sham control. These data demonstrate that incised deep tissue rather than skin is critical for the development of guarding pain and increased SA of DHNs. Skin incision alone is sufficient for primary mechanical and heat hyperalgesia.