Articles: neuralgia.
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Proc. Natl. Acad. Sci. U.S.A. · Sep 2015
RGS9-2-controlled adaptations in the striatum determine the onset of action and efficacy of antidepressants in neuropathic pain states.
The striatal protein Regulator of G-protein signaling 9-2 (RGS9-2) plays a key modulatory role in opioid, monoamine, and other G-protein-coupled receptor responses. Here, we use the murine spared-nerve injury model of neuropathic pain to investigate the mechanism by which RGS9-2 in the nucleus accumbens (NAc), a brain region involved in mood, reward, and motivation, modulates the actions of tricyclic antidepressants (TCAs). ⋯ Furthermore, information from RNA-sequencing analysis reveals that RGS9-2 in the NAc affects the expression of many genes known to be involved in nociception, analgesia, and antidepressant drug actions. Our findings provide novel information on NAc-specific cellular mechanisms that mediate the actions of TCAs in neuropathic pain states.
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Glycine transporter 1 (GlyT1) plays a crucial role in regulating extracellular glycine concentrations and might thereby constitute a new drug target for the modulation of glycinergic inhibition in pain signaling. Consistent with this view, inhibition of GlyT1 has been found to induce antinociceptive effects in various animal pain models. We have shown previously that the lidocaine metabolite N-ethylglycine (EG) reduces GlyT1-dependent glycine uptake by functioning as an artificial substrate for this transporter. ⋯ Additionally, we found that EG reduced the increase in neuronal firing of wide-dynamic-range neurons caused by inflammatory pain induction. These findings suggest that systemically applied lidocaine exerts antihyperalgesic effects through its metabolite EG in vivo, by enhancing spinal inhibition of pain processing through GlyT1 modulation and subsequent increase of glycine concentrations at glycinergic inhibitory synapses. EG and other substrates of GlyT1, therefore, may be a useful therapeutic agent in chronic pain states involving spinal disinhibition.
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There is limited evidence about surgical outcomes after lumbar spinal surgery in patients with neuropathic pain (NP) or the prevalence of NP proportions among patients with degenerative lumbar diseases who are candidates for a surgical interventions. ⋯ There was a high prevalence of NP in Korean patients scheduled for lumbar spine surgery, and these patients suffered greater pain and lower HRQoL than nociceptive pain patients. The more remarkable improvement NP patients showed after treatment highlights the importance of appropriate diagnosis and treatment of NP.
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Reg Anesth Pain Med · Sep 2015
ReviewPercutaneous Balloon Compression for Trigeminal Neuralgia: Imaging and Technical Aspects.
Trigeminal neuralgia attacks are among the most painful conditions known. Trigeminal neuralgias are hypothesized to be caused by neurovascular conflict at the trigeminal root entry zone in the prepontine cistern. A range of therapeutic options is available including open surgical microvascular decompression and several percutaneous ablative techniques (eg, radiofrequency rhizotomy and glycerol gangliolysis). ⋯ This operative approach has proven popular with neurosurgeons as it is considered to be technically easier to perform than other methods. Nevertheless, pain physicians might regard this technique as challenging, relatively risky, and requiring special expertise. Accordingly, in this imaging article, we describe our percutaneous balloon compression procedure, paying particular attention to the technical and radiological details.
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BMJ Support Palliat Care · Sep 2015
Multicenter StudyPharmacovigilance in hospice/palliative care: net effect of gabapentin for neuropathic pain.
Hospice/palliative care patients may differ from better studied populations, and data from other populations cannot necessarily be extrapolated into hospice/palliative care clinical practice. Pharmacovigilance studies provide opportunities to understand the harms and benefits of medications in routine practice. Gabapentin, a γ-amino butyric acid analogue antiepileptic drug, is commonly prescribed for neuropathic pain in hospice/palliative care. Most of the evidence however relates to non-malignant, chronic pain syndromes (diabetic neuropathy, postherpetic neuralgia, central pain syndromes, fibromyalgia). The aim of this study was to quantify the immediate and short-term clinical benefits and harms of gabapentin in routine hospice/palliative care practice. ⋯ Overall, 42% of people experienced benefit at a level that resulted in continued use at 21 days.