المؤلفون: Shiho Shibata, Hideaki Tagashira, Takayuki Nemoto, Satomi Kita, Tomo Kita, Yasuharu Shinoda, Kouzaburo Akiyoshi, Ken Yamaura, Takahiro Iwamoto

المصدر: Journal of Pharmacological Sciences, Vol 153, Iss 1, Pp 1-11 (2023)

مصطلحات موضوعية: Complex regional pain syndrome, Anti-TNF-α antibody, Mechanical allodynia, Edema, Sciatic nerve, Therapeutics. Pharmacology, RM1-950

الوصف: Complex regional pain syndrome (CRPS) is an intractable chronic pain syndrome with various signs and symptoms including allodynia/hyperalgesia, edema, swelling, and skin abnormalities. However, a definitive therapeutic treatment for CRPS has not been established. In CRPS patients, inflammatory cytokines such as TNF-α and IL-1β have been shown to increase in affected areas, suggesting that these molecules may be potential therapeutic targets for CRPS. Here, we first created a novel CRPS mouse model (CRPS-II-like) via sciatic nerve injury and cast immobilization, which was characterized by mechanical allodynia, local edema, and skin abnormalities, to evaluate the pathophysiology and pharmacotherapy of CRPS. When an anti-TNF-α antibody was consecutively administered near the injured sciatic nerve of CRPS model mice, persistent allodynia and CRPS-related signs in the ipsilateral hindpaw were markedly attenuated to control levels. Perineural administration of anti-TNF-α antibody also suppressed the upregulation of inflammatory cytokines as well as the activation of macrophages and Schwann cells in the injured sciatic nerve. These findings indicate that persistent allodynia and CRPS-related signs in CRPS models are primarily associated with TNF-α-mediated immune responses in injured peripheral nerves, suggesting that perineural treatment with anti-TNF-α antibody might be therapeutically useful.

وصف الملف: electronic resource

Relation: http://www.sciencedirect.com/science/article/pii/S134786132300035X; https://doaj.org/toc/1347-8613

URL الوصول: https://doaj.org/article/f27089d75bbf4529a4d8ba03072f0a0d

المؤلفون: Roberta Bonomo, Giulio Bonomo, Emanuele Rubiu, Guglielmo Iess, Giacomo Cammarata, Niccolò Innocenti, Francesco Restelli, Jacopo Falco, Edoardo Porto, Alessia Amato, Edvin Zekaj, Vincenzo Levi

المصدر: Brain and Spine, Vol 4, Iss , Pp 102781- (2024)

مصطلحات موضوعية: Spinal cord stimulation, Neuropathic pain, Complex regional pain syndrome, Failed back surgery syndrome, Neurology. Diseases of the nervous system, RC346-429

الوصف: Introduction: Spinal cord stimulation is a widespread treatment of chronic neuropathic pain from different conditions. Several novel and improving technologies have been recently developed to increase the effect of neuromodulation in patients refractory to pharmacological therapy. Research question: To explore spinal cord stimulation’s mechanisms of action, indications, and management. Material and methods: The paper initially explores the mechanism of action of this procedure based on the generation of an electric field between electrodes placed on the posterior dural surface of the spinal cord probably interfering with the transmission of pain stimuli to the brain. Subsequently, the most consolidated criteria for selecting patients for surgery, which constitute a major issue of debate, were defined. Thereafter, the fundamental patterns of stimulation were summarized by exploring the advantages and side effects. Lastly, the most common side effects and the related management were discussed. Results: Proper selection of the patient is of paramount importance to achieve the best results from this specific neuromodulation treatment. Regarding the different types of stimulation patterns, no definite evidence-based guidelines exist on the most appropriate approach in relation to the specific type of neuropathic pain. Both burst stimulation and high-frequency stimulation are innovative techniques that reduce the risk of paresthesias compared with conventional stimulation. Discussion and conclusion: Novel protocols of stimulation (burst stimulation and high frequency stimulation) may improve the trade-off between therapeutic benefits and potential side effects. Likewise, decreasing the rates of hardware-related complications will be also useful to increase the application of neuromodulation in clinical settings.

وصف الملف: electronic resource

Relation: http://www.sciencedirect.com/science/article/pii/S2772529424000377; https://doaj.org/toc/2772-5294

URL الوصول: https://doaj.org/article/9ce651cb5e384d669b4f994ab600e1b0

المؤلفون: Anurag Modak, Raja Jani, Sushma Jani, Antonios Mammis

المصدر: Interdisciplinary Neurosurgery, Vol 31, Iss , Pp 101633- (2023)

مصطلحات موضوعية: Psychiatric screening, Spinal cord stimulation, Complex regional pain syndrome, Depression, Beck Depression Inventory-II, Surgery, RD1-811, Neurology. Diseases of the nervous system, RC346-429

الوصف: Background: Spinal cord stimulation (SCS) is a well-established, efficacious treatment option for patients suffering from complex regional pain syndrome (CRPS). Psychiatric comorbidities have been shown to be associated with worse SCS outcomes and thus appropriate screening questionnaires have been used to select candidates. Summary: This manuscript aims to examine the existing literature regarding the ability for psychiatric screening tools for SCS to adequately identify psychiatric contraindications to SCS and to propose an evidence-based treatment algorithm. Fifteen different psychological screening tools were identified that are used to assess SCS patients. Analysis of the literature revealed the following psychological factors predisposed patients to SCS failure: depression, anxiety, somatization, catastrophizing, poor coping mechanisms, dysfunctional interpersonal relationships, childhood trauma, and elevated pain perception. There was inconclusive evidence regarding the association between the scores from most psychological tests and the aforementioned predisposing factors or SCS outcomes. Conclusion: Based on the existing literature, our group recommends the Beck Depression Inventory (BDI)-II as the primary psychological screening tool for CRPS patients being considered for SCS. Patients with a BDI-II score > 28 should be counseled to undergo cognitive behavioral therapy (CBT) and seek psychiatric care prior to consideration for SCS.

وصف الملف: electronic resource

Relation: http://www.sciencedirect.com/science/article/pii/S2214751922001475; https://doaj.org/toc/2214-7519

URL الوصول: https://doaj.org/article/031b2ea664e7490fb9665c658fd6acc6

المؤلفون: Jinsol Kim, Eun Namgung, Suji Lee, Eunji Ha, Haejin Hong, Yumi Song, Hyangwon Lee, Sohyun Oh, In Kyoon Lyoo, Sujung Yoon, Hyeonseok Jeong

المصدر: NeuroImage: Clinical, Vol 38, Iss , Pp 103440- (2023)

مصطلحات موضوعية: Complex regional pain syndrome, Insula, functional connectivity, Magnetic resonance imaging, Computer applications to medicine. Medical informatics, R858-859.7, Neurology. Diseases of the nervous system, RC346-429

الوصف: Background: Complex regional pain syndrome (CRPS) is characterized by continued amplification of pain intensity. Given the pivotal roles of the insula in the perception and interpretation of pain, we examined insular functional connectivity and its associations with clinical characteristics in patients with CRPS. Methods: Twenty-one patients with CRPS and 49 healthy controls underwent resting-state functional magnetic resonance imaging. The seed-to-seed functional connectivity analysis was performed for the bilateral insulae and cognitive control regions including the dorsal anterior cingulate cortex (dACC) and bilateral dorsolateral prefrontal cortex (DLPFC) between the two groups. Correlations between altered functional connectivity and clinical characteristics were assessed in CRPS patients. Results: CRPS patients exhibited lower functional connectivity within the bilateral anterior insulae, between the insular and cognitive control regions (the bilateral anterior/posterior insulae-dACC; the right posterior insula-left DLPFC), as compared with healthy controls at false discovery rate-corrected p

وصف الملف: electronic resource

Relation: http://www.sciencedirect.com/science/article/pii/S2213158223001298; https://doaj.org/toc/2213-1582

URL الوصول: https://doaj.org/article/4e91bb356a474f4e830337e8a35864ff

المؤلفون: Mikio Harada, MD, PhD, Masatoshi Takahara, MD, PhD, Nariyuki Mura, MD, PhD, Issei Yuki, MD, Daisaku Tsuruta, MD, PhD, Michiaki Takagi, MD, PhD

المصدر: JSES International, Vol 5, Iss 6, Pp 1077-1085 (2021)

مصطلحات موضوعية: Shoulder, Arthroscopic rotator cuff repair, Finger, Hand, Complex regional pain syndrome, Carpal tunnel syndrome, Orthopedic surgery, RD701-811, Diseases of the musculoskeletal system, RC925-935

الوصف: Hypothesis/Background: Complications involving the fingers and hand after arthroscopic rotator cuff repair (ARCR) include complex regional pain syndrome, carpal tunnel syndrome (CTS), and flexor tenosynovitis (TS). The aims of this study were to diagnose the complications after ARCR and investigate the risk factors that could predispose individuals to these finger and hand complications. Methods: Fifty patients (50 shoulders) who underwent ARCR participated in this study. The patients’ ages ranged from 36 to 84 years (mean, 63 years). Before ARCR, we determined the disease history of the fingers and hand (CTS or TS) and subjectively assessed their symptoms using a questionnaire that included a scale ranging from 1 (no symptoms or no disability) to 5 (the worst symptoms or severest disability). ARCR was performed in all patients using suture anchors. The mean observation period after surgery was 15.5 months (range, 12-48 months). We diagnosed complications involving the fingers and hand after ARCR and investigated the preoperative, intraoperative, and postoperative risk factors that could predispose patients to these complications using univariable and multivariable analyses. Results: After ARCR, 20 patients (20 hands) (40%) had complications of the fingers and hand. Among them, the diagnosis was CTS in 2 hands, TS in 15 hands, and both CTS and TS in 3 hands. None of the hands exhibited complex regional pain syndrome. These complications occurred at an average of 1.8 months (range, 0.1-4 months) after ARCR. In the 47 patients who did not have symptoms just before the operation, both univariable and multivariable analyses between the complication group (n = 17) and the no-complications group (n = 30) showed a significant difference in the presence of a past history of CTS or TS (complication frequency: past history: 88%, no past history: 25%) (P

وصف الملف: electronic resource

Relation: http://www.sciencedirect.com/science/article/pii/S2666638321001869; https://doaj.org/toc/2666-6383

URL الوصول: https://doaj.org/article/c95639564959422e8798db0ed28691cb

المؤلفون: Nolan A. Huck, Lauren J. Donovan, Huaishuang Shen, Claire E. Jordan, Gabriella P.B. Muwanga, Caldwell M. Bridges, Thomas E. Forman, Stephanie A. Cordonnier, Elena S. Haight, Fiona Dale-Huang, Yoshinori Takemura, Vivianne L. Tawfik

المصدر: Neurobiology of Pain, Vol 12, Iss , Pp 100106- (2022)

مصطلحات موضوعية: Microglia, TMEM119, Complex regional pain syndrome, Chronic pain, Sex differences, Neurosciences. Biological psychiatry. Neuropsychiatry, RC321-571

الوصف: Chronic pain is a common and often debilitating problem that affects 100 million Americans. A better understanding of pain’s molecular mechanisms is necessary for developing safe and effective therapeutics. Microglial activation has been implicated as a mediator of chronic pain in numerous preclinical studies; unfortunately, translational efforts using known glial modulators have largely failed, perhaps at least in part due to poor specificity of the compounds pursued, or an incomplete understanding of microglial reactivity. In order to achieve a more granular understanding of the role of microglia in chronic pain as a means of optimizing translational efforts, we utilized a clinically-informed mouse model of complex regional pain syndrome (CRPS), and monitored microglial activation throughout pain progression. We discovered that while both males and females exhibit spinal cord microglial activation as evidenced by increases in Iba1, activation is attenuated and delayed in females. We further evaluated the expression of the newly identified microglia-specific marker, TMEM119, and identified two distinct populations in the spinal cord parenchyma after peripheral injury: TMEM119+ microglia and TMEM119- infiltrating myeloid lineage cells, which are comprised of Ly6G + neutrophils and Ly6G- macrophages/monocytes. Neurons are sensitized by inflammatory mediators released in the CNS after injury; however, the cellular source of these cytokines remains somewhat unclear. Using multiplex in situ hybridization in combination with immunohistochemistry, we demonstrate that spinal cord TMEM119+ microglia are the cellular source of cytokines IL6 and IL1β after peripheral injury. Taken together, these data have important implications for translational studies: 1) microglia remain a viable analgesic target for males and females, so long as duration after injury is considered; 2) the analgesic properties of microglial modulators are likely at least in part related to their suppression of microglial-released cytokines, and 3) a limited number of neutrophils and macrophages/monocytes infiltrate the spinal cord after peripheral injury but have unknown impact on pain persistence or resolution. Further studies to uncover glial-targeted therapeutic interventions will need to consider sex, timing after injury, and the exact target population of interest to have the specificity necessary for translation.

وصف الملف: electronic resource

Relation: http://www.sciencedirect.com/science/article/pii/S2452073X2200023X; https://doaj.org/toc/2452-073X

URL الوصول: https://doaj.org/article/3530f064f537414992f24a30d917900d

المؤلفون: Katsuyuki Iwatsuki, Minoru Hoshiyama, Akihito Yoshida, Jun-ichi Uemura, Aiko Hoshino, Izumi Morikawa, Yasunobu Nakagawa, Hitoshi Hirata

المصدر: IBRO Neuroscience Reports, Vol 10, Iss , Pp 208-215 (2021)

مصطلحات موضوعية: Complex regional pain syndrome (CRPS), Chronic pain, Magnetoencephalography (MEG), Connectivity, Default mode network (DMN), Amplitude envelope correlation (AEC), Neurosciences. Biological psychiatry. Neuropsychiatry, RC321-571

الوصف: Quantitative objective measurement of chronic pain is important. We elucidated chronic pain-related cortical neural activity and neural connectivity among pain-related brain regions in complex regional pain syndrome (CRPS). Resting-state magnetoencephalography recordings were performed. Cortical current density and neural connectivity, revealed by amplitude envelope correlation (AEC), were estimated on standardized brain magnetic resonance imaging. Intra-experiment pain was assessed subjectively using a visual analogue scale (VAS). The correlation between current density and VAS scores was calculated for the occipital areas and pain-related cortices. Current density in the primary (SI) and secondary (SII) somatosensory cortex and precuneus in both hemispheres was negatively correlated with the pain VAS score. The AEC and VAS values were significantly correlated for the SII and the precuneus and for the SII and insular cortex in the alpha frequency band in the right hemisphere. In the theta frequency band, the AEC and VAS values correlated for the SII and posterior cingulate cortex in the right hemisphere. Our results suggested that disruption of pain processes and functions in the default mode network occurs in CRPS. Our method targeting the neural mechanism of pain has the potential to offer a clinically objective means of evaluating it.

وصف الملف: electronic resource

Relation: http://www.sciencedirect.com/science/article/pii/S266724212100021X; https://doaj.org/toc/2667-2421

URL الوصول: https://doaj.org/article/a4a471ed70784e86b1950c5c54bdca09

المؤلفون: Mikio Harada, MD, PhD, Nariyuki Mura, MD, PhD, Masatoshi Takahara, MD, PhD, Daisaku Tsuruta, MD, PhD, Michiaki Takagi, MD, PhD

المصدر: JSES International, Vol 4, Iss 3, Pp 612-618 (2020)

مصطلحات موضوعية: Shoulder, arthroscopic rotator cuff repair, finger, hand, complex regional pain syndrome, carpal tunnel syndrome, Orthopedic surgery, RD701-811, Diseases of the musculoskeletal system, RC925-935

الوصف: Background: Complications in the fingers and hand after arthroscopic rotator cuff repair (ARCR) have been reported to include carpal tunnel syndrome (CTS), flexor tenosynovitis (TS), and complex regional pain syndrome. These studies were conducted retrospectively; however, the reported complications have not been examined prospectively. The aim of this study was to evaluate the outcomes of early detection and treatment of the complications after ARCR. Methods: Forty-six patients (48 shoulders) who underwent ARCR were prospectively examined to investigate complications in the fingers and hand after ARCR. We attempted to immediately detect and proactively treat these complications. We evaluated the outcomes of the early detection and treatment of the complications. Results: Complications were observed in 17 hands (35%) and occurred an average of 1.5 months after ARCR. The symptoms in 3 hands resolved spontaneously, 2 hands were diagnosed with CTS, and 12 hands were diagnosed with TS. Of the 12 hands with TS, 11 exhibited no triggering of the fingers. Among the 14 hands diagnosed with CTS or TS, 13 hands (CTS: 2 hands, TS: 11 hands) were treated with corticosteroid injections; the mean interval between treatment initiation and symptom resolution was 1.0 months (0.5-3.0 months). None exhibited complex regional pain syndrome. Conclusions: When symptoms occur in the fingers and hand after ARCR, CTS or TS should be primarily suspected. The diagnosis of TS must be made carefully because most patients with TS have no triggering. For patients with CTS or TS after ARCR, rapid corticosteroid injection administration can lead to improvement in these symptoms.

وصف الملف: electronic resource

Relation: http://www.sciencedirect.com/science/article/pii/S2666638320300773; https://doaj.org/toc/2666-6383

URL الوصول: https://doaj.org/article/e49646b5ab944ef3afc14fd16ff7367e

المؤلفون: Amida Kuah, DPM, Carlos Arroyo, DPM, FACFAS, Luis Rivera, MD

المصدر: Foot & Ankle Surgery: Techniques, Reports & Cases, Vol 2, Iss 3, Pp 100237- (2022)

مصطلحات موضوعية: Adductovarus rearfoot deformity, Complex regional pain syndrome, Dystonia, Rearfoot reconstruction, Surgery, RD1-811

الوصف: Fixed dystonia secondary to complex regional pain syndrome is a rare condition, which is usually triggered by a traumatic injury. Complete remission of complex regional pain syndrome dystonia rarely occurs due to the complex nature of the pathology and limited treatment options. Here we present a case of complex regional pain syndrome dystonia in a 39 year old female, our multidisciplinary treatment approach, and surgical treatment plan. After sustaining a fall, the patient developed a rigid adductovarus rearfoot alongside complex regional pain symptoms. In conjunction with medical management with neurology, a soft tissue reconstructive surgery and a second osseous reconstructive surgery the patient was once again able to ambulate pain free with a plantigrade foot.LOCE: 4, case study

وصف الملف: electronic resource

Relation: http://www.sciencedirect.com/science/article/pii/S2667396722000945; https://doaj.org/toc/2667-3967

URL الوصول: https://doaj.org/article/03b2e2659c0a445daaa319fcdaf12b1f

المؤلفون: Noriyuki Yahagi, Masahito Kobayashi, Kenji Wakiya, Sachiko Hirata, Takamitsu Fujimaki

المصدر: Interdisciplinary Neurosurgery, Vol 26, Iss , Pp 101297- (2021)

مصطلحات موضوعية: Spinal cord stimulation, Complex regional pain syndrome, Thermography, Surgery, RD1-811, Neurology. Diseases of the nervous system, RC346-429

الوصف: Complex Regional Pain Syndrome (CRPS) is a form of chronic pain affecting one arm or leg. Spinal cord stimulation (SCS) is one of the few effective treatments for CRPS. However, it is difficult to objectively determine the appropriate conditions of CRPS and predict the efficacy of SCS.In this case report, we report a 21-year-old woman with CRPS type I, who had a history of meniscus injury in the left knee at age 15. Her motor and sensory symptoms in the left lower extremity improved dramatically with SCS. Thermography imaging showed a significant change in the skin temperature of the left lower limb before and after surgery, which can be useful in objectively assessing the therapeutic effect.

وصف الملف: electronic resource

Relation: http://www.sciencedirect.com/science/article/pii/S2214751921002097; https://doaj.org/toc/2214-7519

URL الوصول: https://doaj.org/article/f855dde3306443bc8536db9f6e80728f