Articles: neuropathic-pain.
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Comparative Study
A retrospective study of open thoracotomies versus thoracoscopic surgeries for persistent postthoracotomy pain.
Persistent thoracotomy pain syndrome (PTPS) is a recognized complication and is considered to be less after video-assisted thoracoscopic surgery (VATS) compared with open thoracic surgery (OTS). The primary objective was to compare the incidence of PTPS at 6 months. Secondary objectives were to compare the incidence of neuropathic pain between VATS and OTS and to report perioperative factors associated with the development of PTPS. ⋯ Our study indicates that PTPS is significantly more common and has a higher chance of being neuropathic with OTS. Despite being relatively less traumatic, VATS still carries a significant potential for PTPS. A diagnosis of cancer and history of previous pain are highly predictive of its development.
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J Pain Palliat Care Pharmacother · Dec 2016
ReviewMemantine for the Treatment of Phantom Limb Pain: A Systematic Review.
Phantom limb pain (PLP) occurs in up to 85% of patients who have undergone an amputation and remains difficult to treat. Memantine is a N-Methyl-d-aspartate receptor antagonist that has shown benefit in pain syndromes. The objective of this systematic review is to evaluate the evidence for the use of memantine in the treatment of acute and chronic PLP. ⋯ Memantine was well tolerated in all studies. Memantine appears to be a reasonable option to trial in a patient with a recent amputation or who has failed or cannot tolerate other analgesics. Additional research is needed to further determine the role of memantine in the treatment and prevention of PLP and to identify the population most likely to gain benefit.
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This study aimed to characterize the prevalence of various pain qualities in older adults with chronic nonmalignant pain and determine the association of pain quality to other pain characteristics namely: severity, interference, distribution, and pain-associated conditions. In the population-based MOBILIZE Boston Study, 560 participants aged ≥70 years reported chronic pain in the baseline assessment, which included a home interview and clinic exam. Pain quality was assessed using a modified version of the McGill Pain Questionnaire (MPQ) consisting of 20 descriptors from which 3 categories were derived: cognitive/affective, sensory, and neuropathic. ⋯ Findings from this study indicate that older adults have multiple pain-associated conditions that likely reflect multiple physiological mechanisms for pain. Linking pain qualities with other associated pain characteristics serve to develop a multidimensional approach to geriatric pain assessment. Future research is needed to investigate the physiological mechanisms responsible for the variability in pain qualities endorsed by older adults.
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Case Reports
Inhibition of Somatosensory Evoked Potentials During Different Modalities of Spinal Cord Stimulation: A Case Report.
Although the number of patients with chronic neuropathic pain treated by spinal cord stimulation (SCS) is continuously increasing, its analgesic mechanism remains to be elucidated. Previous studies have demonstrated that classical SCS (low stimulation frequency evoking paresthesia) inhibits the somatosensory evoked potentials (SEPs). ⋯ All the tested SCS modalities are able to inhibit SEPs and thus the lemniscal system. In particular, both paresthesia and paresthesia free SCS affect SEPs in the same manner. The presence of this inhibitory effect during paresthesia free modalities suggests that it is independent from the generation of action potentials, with a probable mechanism acting at the stimulation site. Further studies investigating the relationship between the inhibition of the lemniscal system and the analgesic effect of the SCS are, therefore, warranted.
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Transforming growth factor-βs (TGF-βs) are a group of multifunctional proteins that have neuroprotective roles in various experimental models. We previously reported that intrathecal (i.t.) injections of TGF-β1 significantly inhibit neuropathy-induced thermal hyperalgesia, spinal microglia and astrocyte activation, as well as upregulation of tumor necrosis factor-α. However, additional cellular mechanisms for the antinociceptive effects of TGF-β1, such as the mitogen-activated protein kinase (MAPK) pathway, have not been elucidated. During persistent pain, activation of MAPKs, especially p38 and extracellular signal-regulated kinase (ERK), have crucial roles in the induction and maintenance of pain hypersensitivity, via both nontranscriptional and transcriptional regulation. In the present study, we used a chronic constriction injury (CCI) rat model to explore the role of spinal p38 and ERK in the analgesic effects of TGF-β1. ⋯ The present results demonstrate that suppressing p38 and ERK activity affects TGF-β1-induced analgesia during neuropathy.