Acute Pain Syndrome Research Articles

Występowanie zaburzeń odżywiania wśród pacjentów hospitalizowanych z powodu udaru i dyskopatii na oddziale neurologicznym

ENWEndNote BIBJabRef, Mendeley RISPapers, Reference Manager, RefWorks, Zotero AMA Sierżantowicz R, Jakimiuk L, Lewko J, Stępień R, Trochimowicz L, Zimnoch R. Prevalence nutritional disorders among patients hospitalised for stroke and discopathy in the neurology department. Medical Studies/Studia Medyczne. 2015;31(3):187-193. doi:10.5114/ms.2015.54758. APA Sierżantowicz, R., Jakimiuk, L., Lewko, J., Stępień, R., Trochimowicz, L., & Zimnoch, R. (2015). Prevalence nutritional disorders among patients hospitalised for stroke and discopathy in the neurology department. Medical Studies/Studia Medyczne, 31(3), 187-193. https://doi.org/10.5114/ms.2015.54758 Chicago Sierżantowicz, Regina, Lucyna Jakimiuk, Jolanta Lewko, Renata Stępień, Lech Trochimowicz, and Ryszard Zimnoch. 2015. "Prevalence nutritional disorders among patients hospitalised for stroke and discopathy in the neurology department". Medical Studies/Studia Medyczne 31 (3): 187-193. doi:10.5114/ms.2015.54758. Harvard Sierżantowicz, R., Jakimiuk, L., Lewko, J., Stępień, R., Trochimowicz, L., and Zimnoch, R. (2015). Prevalence nutritional disorders among patients hospitalised for stroke and discopathy in the neurology department. Medical Studies/Studia Medyczne, 31(3), pp.187-193. https://doi.org/10.5114/ms.2015.54758 MLA Sierżantowicz, Regina et al. "Prevalence nutritional disorders among patients hospitalised for stroke and discopathy in the neurology department." Medical Studies/Studia Medyczne, vol. 31, no. 3, 2015, pp. 187-193. doi:10.5114/ms.2015.54758. Vancouver Sierżantowicz R, Jakimiuk L, Lewko J, Stępień R, Trochimowicz L, Zimnoch R. Prevalence nutritional disorders among patients hospitalised for stroke and discopathy in the neurology department. Medical Studies/Studia Medyczne. 2015;31(3):187-193. doi:10.5114/ms.2015.54758.

LA RUPTURE UTERINE SPONTANEE SUR UTERUS NON CICATRICIEL EN COURS DE GROSSESSE : A PROPOS DE DEUX OBSERVATIONS ET REVUE DE LA LITTERATURE

The occurrence of spontaneous uterine rupture on unscarred gravid uterus is an exceptional event during pregnancy. We report the clinical findings of two patients who experienced spontaneous uterine rupture during pregnancy. The rupture was found in both cases by acute abdominal pain syndrome associated with an array of intraperitoneal hemorrhage. No maternal death was lamented. The fetal outcome was dramatic in both cases. Support is an effective resuscitation followed by surgical hemostasis. Based on our observations and various published articles, we recall aspects etiopathogenic, clinical and therapeutic of spontaneous uterine rupture on unscarred gravid uterus during pregnancy. Keywords: hemoperitoneum - pregnancy – uterine rupture – unscarred uterus

Long-term-treatment of chronic pain patients with flupirtine--on hepatotoxicity and persistent effectiveness from 7 months to 22 years

After an extended series of investigations in animals, healthy volunteers and pain patients with different methods, flupirtine was introduced in 1986 into the German market. Flupirtine has a unique chemical structure and differs in its profile of effects and side effects from established NSAIDs (non-steroidal anti-inflammatory drugs) on the one hand and from opioids on the other hand. In the years after introduction, muscle relaxing effects were observed and experimentally shown. They were therapeutically utilized in tension-associated pain. Evidence of the efficacy in acute and chronic musculoskeletal pain syndromes was verified in many controlled and in open studies. Experience report and case presentation The report in this paper of long-term treatment of chronic pain patients from 7 months to 22 years principally confirms its persistent effectiveness and tolerability. Tiredness and dizziness are frequent side effects. Flupirtine-associated hepatotoxicities are rare events. For pain patients for which NSAIDs or opioids are contraindicated or in appropriate, flupirtine is a necessary option.

The role of delayed contrast-enhanced cardiac magnetic resonance in differentiating myocarditis from myocardial infarction

A number of different conditions can present with symptoms that mimics acute coronary syndrome (ACS). Even after performing coronary angiography, diagnosis can still be challenging. The aim of this study was to evaluate the utility of contrast-enhanced cardiac magnetic resonance (CMR) to differentiate between myocarditis and myocardial infarction (MI) in patients presenting with acute chest pain syndrome, elevated cardiac markers, and unobstructed coronary arteries. We studied 26 consecutive patients (mean age 32.4+ 11.3 years, 80.1% males) presenting with acute symptoms, elevated cardiac markers, unobstructed coronary arteries, and referred for Gadolinium-enhanced CMR examinations. Myocarditis was ascertained by the presence of myocardial edema and/or epicardial or scattered intra-myocardial late gadolinium enhancement (LGE). Myocardial infarction was diagnosed if there was territorial subendocardial LGE with variable degrees of transmural involvement. In patients with no LGE, the diagnosis was uncertain. Of 26 patients, 15 (57.7%) were initially diagnosed with ACS, the majority (8 patients, 53.3%) had LGE pattern of myocarditis, 4 (26.7%) had LGE pattern of MI. The remaining 11 patients had suspected myocarditis, 2 (18.2%) had LGE pattern of MI, and 7 (63.6%) had LGE pattern of myocarditis. Five (19.2%) patients had no LGE and diagnosis was unclear. Cardiac magnetic resonance helped to reclassify more than half of our patients (57.7%). We demonstrated that contrast-enhanced CMR allows differentiation between MI and myocarditis in patients presenting with possible ACS and unobstructed coronary arteries. This, in turn, helps with planning long-term therapeutic strategies and redefines the patient’s future risk.

Combination treatment for acute non-specific low back pain

Spinal pain syndromes come to the forefront in the structure of referral rates for medical advice and considerably reduce quality of life in this category of patients. The paper considers the role of an edematous component in the development and chronization of pain. Occurring edema gives rise to local hemo- and lymphodynamic disorders, dysregulated vascular tone, activated thrombogenesis, and increased vascular permeability, eventually leading to the excessive irritation of nociceptors, the enhancement of a pain component, and the progression of tissue swelling. Objective: to study the efficacy of L-lysine escinate in the combination treatment of acute non-specific low back pain. Patients and methods. Sixty-two patients aged 21 to 53 patients (mean age 36.4±0.9 years) with acute low back pain were examined. L-lysine escinate having venotonic and anti-inflammatory activities was chosen as an agent to correct edema syndrome. The results of clinical, neurological, and manual muscular testing and assessment of the biomechanics of the vertebral column, obtained using the original soft package “Visual optic analysis” developed by the authors, were analyzed. All the patients were found to have acute non-specific low back pain or radiculopathy (entrapment syndrome) and considerable changes in the biomechanics of the vertebral column. The patients were treated in accordance with the standards of medical care for spinal pain. L-lysine escinate was additionally incorporated as an antiedema drug into the therapeutic complex of the patients in the study group. Results and discussion. The study patient group demonstrated a more pronounced trend towards reductions in pain syndrome and local muscle edema. It was noted that L-lysine escinate was effective in treating both acute pain syndromes and exacerbations of chronic low back pain and that additional non-drug programs should be included in order to correct an impaired motor stereotype.

370 Acute Management of Pain from the Emergency Department: Initial Report of a Patient-Reported Outcomes Registry

370 Acute Management of Pain from the Emergency Department: Initial Report of a Patient-Reported Outcomes Registry

An unusual cause of acute cor pulmonale – Significance of the ‘continuous diaphragm sign’

A patient presented with chest pain and clinical features of acute right heart failure. Initial work up revealed the presence of severe PAH. Acute pulmonary embolism is the commonest and most life-threatening cause for acute cor pulmonale. Even though the clinical picture suggested pulmonary embolism, a subtle sign was missed from the first chest X-ray taken in the emergency department. However on reanalysis the ‘continuous diaphragm sign’ later guided us towards the diagnosis. Our case represents one of the first reports of a rare etiology for acute cor pulmonale – hypersensitivity pneumonitis. Right ventricular dysfunction was caused by an acute rise in pulmonary artery pressures as well as by the compressive effects of pneumomediastinum. We emphasize the role played by a good quality chest X-ray early in the management of acute chest pain syndromes. However pulmonary embolism should be ruled out conclusively before redirecting attention to less malignant conditions.

Psychological impact of cancer pain on patients and their quality of life.

British Journal of NursingVol. 23, No. 14 RegularsPsychological impact of cancer pain on patients and their quality of lifeEmma ElliottEmma ElliottSearch for more papers by this authorEmma ElliottPublished Online:25 Jul 2014https://doi.org/10.12968/bjon.2014.23.14.805AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References American Pain Foundation (2003) Pain Care: Bill of Rights. APF, Baltimore. http://tinyurl.com/ohoxhea (accessed 17 July 2014) Google ScholarDepartment of Health (DH) (2013) Holistic Needs Assessment. http://tinyurl.com/opxknth (accessed 17 July 2014) Google ScholarFoley KM. Acute and chronic cancer pain syndromes. In: Doyle DHanks GCherny NCalman K, eds. Oxford Textbook of Palliative Medicine. OUP, Oxford: 298–316 Google ScholarFrancis R (2013) The Mid Staffordshire NHS Foundation Trust Public Inquiry Final Report. http://www.midstaffspublicinquiry.com/report (accessed 16 July 2014) Google ScholarLeadership Alliance for the Care of Dying People (2014) One Chance to Get it Right. http://tinyurl.com/mad2kql (accessed 16 July 2014) Google ScholarMacmillan Cancer Support (2014) Cancer and Complementary Therapies. http://tinyurl.com/naxgchs (accessed 17 July 2014) Google ScholarMcCaffrey M (1983) Nursing the Patient in Pain, 2nd edn. Harper and Row, London Google ScholarPincock S (2004) Poor communication lies at heart of NHS complaints, says ombudsman. BMJ 328: 10. doi: https://doi.org/http://dx.doi.org/10.1136/bmj.328.7430.10-d Crossref, Google ScholarQuality Health (2013) National Cancer Patient Experience Survey. http://tinyurl.com/ngr4f5g (accessed 17 July 2014) Google ScholarScottish Intercollegiate Guidelines Network (2000) Control of pain in adults with cancer. A national clinical guideline (106). http://www.sign.ac.uk/pdf/SIGN106.pdf (accessed 16 July 2014) Google ScholarThe British Pain Society (2010) Cancer Pain Management. http://tinyurl.com/nalpdxe (accessed 17 July 2014) Google ScholarTwycross R, Bennett M (2008) Cancer pain syndromes. In: Sykes NBennett MIYuan C-S. Clinical pain management: Cancer pain, 2nd edn. Hodder Arnold, London: 27–37 Google ScholarWorld Health Organization (1986) Cancer Pain Relief. WHO, Geneva Google Scholar FiguresReferencesRelatedDetailsCited bySignature Informed Consent for Long-Term Opioid Therapy in Patients With Cancer: Perspectives of Patients and ProvidersJournal of Pain and Symptom Management, Vol. 59, No. 1Frontiers in Psychology, Vol. 10Relieving pressure – An evaluation of Shiatsu treatments for cancer & palliative care patients in an NHS settingEuropean Journal of Integrative Medicine, Vol. 21 24 July 2014Volume 23Issue 14ISSN (print): 0966-0461ISSN (online): 2052-2819 Metrics History Published online 25 July 2014 Published in print 24 July 2014 Information© MA Healthcare LimitedPDF download

Assessment of the Effect of Pain on Daily Functioning of Patients with the Diagnosed Back Pain Syndrome

Introduction. The back pain syndrome is one of the most common health problem of the contemporary society. Acute pain syndromes of the lower section of the spine affect 28 people per 1000 inhabitants. The disease more often affects men aged 25–64. In the population of one hundred thousand inhabitants 107 men and 64 women suffer from acute pain syndrome of the cervical spine. Most often the pain occurs between 50 and 54 years of age. Also, back pain syndromes constitute a serious economic problem for the contemporary society as they are statistically the most frequent in the case of men and the second in the case of women reason for absence from work, and in 20% of cases they indicate the necessity of granting disability pension due to permanent inability to work.Aim. Assessment of pain intensity effect on daily functioning of patients diagnosed with the back pain syndrome.Material and Methods. The research included 187 patients diagnosed with back pain syndrome aged from 20 to 83 years and it was carried out in April and May 2013. The diagnostic survey method and statistical analysis were applied.Results. The most difficult issue for the respondents in their daily functioning was to accept permanent pain stimuli (100%), permanent stiffness in the back or neck, (96.33%), copying with the pain when the performance of everyday duties required prolonged sitting or standing (99.47%) as well as the performance of daily household activities (100%). Back pain to greater or lesser extent resulted in the loss of control over major spheres of everyday life in the respondents, on average from 3.34 to 6.37 on the scale from 1 to 10 points. All respondents admitted having problems with remaining in the sitting position for a long time. The average loss of fitness in the group of respondents ranged 39.30±18.09 points (Me=37; range from 7 to 88 points). Based on the average value ± 1 SD it was stated that 16.58% (n=31) of respondents had light malfunction, whereas 65.78% (n=123) had moderate and 17.64% (n=33) serious.Conclusions. 1. Chronic back pain has a devastating impact on the daily functioning of patients with diagnosed spinal pain syndrome 2. The most difficult issue for the respondents in their daily functioning was to accept permanent pain stimuli 3. The average strength of the negative impact of the back pain on daily functioning ranged from 6.25 to 6.49 in the scale from 1 to 10 points. 4. All respondents admitted that back pain to greater or lesser extent resulted in a loss of control over major spheres of everyday life. 5. Just over a quarter of respondents (25.13%) did not have major problems, resulting from the pain, with the performance of daily duties at work. 6. For more than three quarters of the respondents (77.01%) pain while sitting in the chair for a few hours was a significant problem in everyday functioning. 7. The statistical analysis carried out, showed a significant correlation between the intensity of the back pain and lowering of physical fitness. (JNNN 2014;3(4):157–168)

The Use of Coronary CT Angiography for the Evaluation of Chest Pain

Coronary computed tomography angiography (CCTA) may improve the diagnosis and management of acute and stable chest pain syndromes. The key for caregivers of patients presenting with acute chest pain is the early identification and management of life-threatening conditions, such as acute coronary syndromes, pulmonary embolism, and acute aortic dissection. The main goal in stable chest pain syndromes is to determine the extent and severity of coronary artery disease. This review article will critically evaluate the current literature supporting the evidence for the clinical use of CCTA in acute and stable chest pain syndromes, considering the latest innovations in CCTA technology and their potential impact on patient care.

North Central Cancer Treatment Group/Alliance trial N08CA—the use of glutathione for prevention of paclitaxel/carboplatin‐induced peripheral neuropathy: A phase 3 randomized, double‐blind, placebo‐controlled study

Chemotherapy-induced peripheral neuropathy (CIPN) is a significant side effect of taxane and platinum-based chemotherapy. Several studies have supported the potential benefit of glutathione for the prevention of platinum-induced CIPN. The current trial was designed to determine whether glutathione would prevent CIPN as a result of carboplatin/paclitaxel therapy. In total, 185 patients who received treatment with paclitaxel and carboplatin were accrued between December 4, 2009 and December 19, 2011. Patients were randomized to receive either placebo (n = 91) or 1.5 g/m(2) glutathione (n = 94) over 15 minutes immediately before chemotherapy. CIPN was assessed using the European Organization for Research and Treatment of Cancer Quality-of-Life (EORTC-QLQ) 20-item, CIPN-specific (CIPN20) sensory subscale and the National Cancer Institute Common Terminology Criteria for Adverse Events (CTCAE), version 4.0. There were no statistically significant differences between the 2 study arms with regard to: 1) peripheral neurotoxicity, as assessed using both the EORTC-QLQ-CIPN20 (P = .21) and the CTCAE scales (P = .449 for grade ≥2 neurotoxicity; P = .039 for time to development of grade ≥2 neuropathy, in favor of the placebo); 2) the degree of paclitaxel acute pain syndrome (P = .30 for patients who received paclitaxel every 3-4 weeks and P = .002, in favor of the placebo, for patients who received weekly paclitaxel); 3) the time to disease progression (P = .63); or 4) apparent toxicities. Subgroup analyses did not reveal any evidence of benefit in any particular subgroup. The results from this study do not support the use of glutathione for the prevention of paclitaxel/carboplatin-induced CIPN.

Цервикалгии: рациональный выбор противоболевой терапии

В статье приводятся причины возникновения цервикалгий, описываются клинические синдромы, возникающие у пациентов с шейным остеохондрозом, уделяется внимание вопросам лечения. Даны подробная характеристика и обоснование использования при вертеброгенных цервикалгиях препарата Ксефокам, а также схемы его применения. На основании данных клинического исследования эффективности сочетания Ксефокама и комплекса витаминов группы В (препарат Нейробион) у пациентов с цервикалгией вертеброгенного генеза сделан вывод о целесообразности применения этих препаратов при острых цервикальных болевых синдромах.

Neuropeptide Receptors in Pain Circuitries: Useful Targets for CNS Imaging with Non-Peptide Ligands Suitable for PET?

Neuropeptide receptors of the brain and spinal cord are parts of the pain circuits targeted by analgesic drugs. Some of these receptors have been found in the central nervous system as well as in intracranial vascular structures and achieved revival of attention because of their role in acute and chronic pain syndromes. A number of them are of high clinical relevance for e.g. migraine. Others participate in symptoms of rare diseases like amyotrophic lateral sclerosis. Here we will focus on five of the neuropeptide receptors and their non-peptide ligands potentially or already successfully used as PET probes. Opioid receptors and neurotensin receptors are known to mediate analgesic actions. Bradykinin and calcitonin gene-related peptide (CGRP) receptors are known to be involved in the regulation of vascular tone and inflammatory responses, and neurokinin receptors play a role in the occurrence of pain perception in a rather indirect manner. Most experiences as PET tracers have been gathered with opioid receptor ligands and neurokinin receptor ligands. The most innovative fields revealed by the studies summarized in this report are the ligands of κ opioid receptors and CGRP receptors for which a first PET tracer was presented recently.

Perioperative factors affecting the occurrence of acute complex regional pain syndrome following limb bone fracture surgery: data from the Japanese Diagnosis Procedure Combination database

Complex regional pain syndrome (CRPS) describes a broad spectrum of symptoms that predominantly localize to the extremities. Although limb fracture is one of the most frequently reported triggering events, few large-scale studies have shown the occurrence of and factors associated with CRPS following limb fracture. This study aimed to show the occurrence and identify of those factors. Using the Japanese Diagnosis Procedure Combination database, we identified 39 patients diagnosed with CRPS immediately after open reduction and internal fixation (ORIF) for limb fracture from a cohort of 185 378 inpatients treated with ORIF between 1 July and 31 December of each year between 2007 and 2010. Patient and clinical characteristics such as age, gender, fracture site, duration of anaesthesia and use of regional anaesthesia were investigated by logistic regression analyses to examine associations between these factors and the in-hospital occurrence of CRPS after ORIF. The occurrence of CRPS was relatively high in fractures of the distal forearm, but low in fractures of the lower limb and in patients with multiple fractures. Generally females are considered to be at high risk of CRPS; however, we found a comparable number of male and female patients suffering from CRPS after ORIF for limb fracture. In terms of perioperative factors, a longer duration of anaesthesia, but not regional anaesthesia, was significantly associated with a higher incidence of CRPS. Although a limited number of CRPS patients were analysed in this study, reduced operative time might help to prevent the development of acute CRPS following limb fracture.

Inflammation in CRPS: Role of the sympathetic supply

Acute Complex Regional Pain Syndrome (CRPS) is associated with signs of inflammation such as increased skin temperature, oedema, skin colour changes and pain. Pro-inflammatory cytokines (tumour necrosis factor-α (TNF-α), interleukin-2 (IL-2), IL-1beta, IL-6) are up-regulated, whereas anti-inflammatory cytokines (IL-4, IL-10) are diminished. Adaptive immunity seems to be involved in CRPS pathophysiology as many patients have autoantibodies directed against β2 adrenergic and muscarinic-2 receptors. In an animal tibial fracture model changes in the innate immune response such as up-regulation of keratinocytes are also found. Additionally, CRPS is accompanied by increased neurogenic inflammation which depends mainly on neuropeptides such as CGRP and Substance P. Besides inflammatory signs, sympathetic nervous system involvement in CRPS results in cool skin, increased sweating and sympathetically-maintained pain. The norepinephrine level is lower in the CRPS-affected than contralateral limb, but sympathetic sprouting and up-regulation of alpha-adrenoceptors may result in an adrenergic supersensitivity. The sympathetic nervous system and inflammation interact: norepinephrine influences the immune system and the production of cytokines. There is substantial evidence that this interaction contributes to the pathophysiology and clinical presentation of CRPS, but this interaction is not straightforward. How inflammation in CRPS might be exaggerated by sympathetic transmitters requires further elucidation.

Pregnancy-associated osteoporosis with eight fractures in the vertebral column treated with kyphoplasty and bracing: a case report

Pregnancy-associated osteoporosis is a rare condition, which imposes multiple symptoms in the musculoskeletal system. Common complaints announced by patients are severe pain in the lower back, hips and the joints of the lower extremities with a reduced and less mobility status in general. Most of the patients' problems occur in the last trimester of pregnancy or postpartum and are often not diagnosed as side effects of osteoporosis but as problems associated with pregnancy. Although vertebral fractures are rare complications of pregnancy-associated osteoporosis, they should be always considered in women presenting with an acute pain syndrome in peripregnancy period. This case presents a 40-year-old primagravid woman who developed pain in hips and severe pain in the lower back causing an immobilization diagnosed with a pregnancy-associated osteoporosis with eight compression fractures in the thoracic and lumbar spine. Because of sagittal imbalance of the spine, she was treated with kyphoplasty at the four lumbar fractures and with bracing for the upper, thoracic ones, additional to the conservative anti-osteoporotic therapy. The authors discuss pregnancy-associated osteoporosis and its clinical presentation, as well as the indications of kyphoplasty, spinal alignment and the risk of single conservative treatment.

Efficiency of trunk stabilizing exercises in treatment of patients with lumbar pain syndrome

Introduction: Lumbar pain syndrome is the most common cause of temporary work disability in people under 45 years of age. The aim of this study was to detect the frequency of acute and chronic lumbar painsyndrome in people of both gender, different age structures, different occupations and in active working population, and to determine the efficiency of trunk stabilizing exercises in its treatment.Methods: We analyzed 27 patients with acute and 33 patients with chronic lumbar pain syndrome from 01.01.2010 to 31.12.2012 which undergone trunk stabilizing exercises. We evaluated and scored 0 to 5the condition of respondents before treatment and after the treatment.Research results: The mean score of condition of respondents with acute lumbar pain syndrome before therapy is 2.96, whereas after treatment is 4.71. The mean score of condition of respondents with chroniclumbar pain syndrome before therapy is 3.76, whereas after treatment is 4.63.Conclusion: Treatment with trunk stabilizing exercises performed in the clinic "Praxis” leads to improved scores of condition of respondents after treatment.

Ischaemic memory imaging using metabolic radiopharmaceuticals: overview of clinical settings and ongoing investigations

"Ischaemic memory" is defined as a prolonged functional and/or biochemical alteration remaining after a particular episode of severe myocardial ischaemia. The biochemical alteration has been reported as metabolic stunning. Metabolic imaging has been used to detect the footprint left by previous ischaemic episodes evident due to delayed recovery of myocardial metabolism (persistent dominant glucose utilization with suppression of fatty acid oxidation). β-Methyl-p-[(123)I]iodophenylpentadecanoic acid (BMIPP) is a single-photon emission computed tomography (SPECT) radiotracer widely used for metabolic imaging in clinical settings in Japan. In patients with suspected coronary artery disease but no previous myocardial infarction, BMIPP has shown acceptable diagnostic accuracy. In particular, BMIPP plays an important role in the identification of prior ischaemic insult in patients arriving at emergency departments with acute chest pain syndrome. Recent data also show the usefulness of (123)I-BMIPP SPECT for predicting cardiovascular events in patients undergoing haemodialysis. Similarly, SPECT or PET imaging with (18)F-FDG injected during peak exercise or after exercise under fasting conditions shows an increase in FDG uptake in postischaemic areas. This article will overview the roles of ischaemic memory imaging both under established indications and in ongoing investigations.

Favorable Outcome of an Acute Complex Regional Pain Syndrome With Immunoglobulin Infusions

To emphasize that complex regional pain syndrome (CRPS), a disabling disorder with the implication of aberrant inflammation, vasomotor dysfunction, and maladaptive neuroplasticity, might be treated with a high dose of intravenous immunoglobulin infusions (IVIG). We describe a patient who presented with CRPS in the acute phase of the disease. The CRPS developed secondary to sciatic compression in a young patient and was treated within 10 days by high-dose IVIG (2 g/kg). It resolved completely within days after infusions. This observational study emphasizes that high-dose IVIG may be a treatment option in the acute phase of CRPS.

Effect of ω-conotoxin MVIIA and Phα1β on paclitaxel-induced acute and chronic pain

The treatment with the chemotherapeutic agent paclitaxel produces a painful peripheral neuropathy, and is associated with an acute pain syndrome in a clinically significant number of patients. However, no standard therapy has been established to manage the acute pain or the chronic neuropathic pain related to paclitaxel. In the present study, we evaluated the analgesic potential of two N-type voltage-gated calcium channel (VGCC) blockers, ω-conotoxin MVIIA and Phα1β, on acute and chronic pain induced by paclitaxel. Adult male rats were treated with four intraperitoneal injections of paclitaxel (1+1+1+1mg/kg, in alternate days) and the development of mechanical hyperalgesia was evaluated 24h (acute painful stage) or 15days (chronic painful stage) after the first paclitaxel injection. Not all animals showed mechanical hyperalgesia 24h after the first paclitaxel injection, but those that showed developed a more intense mechanical hyperalgesia at the chronic painful stage. Intrathecal administration (i.t.) of ω-conotoxin MVIIA (3–300pmol/site) or Phα1β (10–300pmol/site) reduced the mechanical hyperalgesia either at the acute or at the chronic painful stage induced by paclitaxel. When administered at the acute painful stage, ω-conotoxin MVIIA (300pmol/site, i.t.) and Phα1β (300pmol/site, i.t.) prevented the worsening of chronic mechanical hyperalgesia. Furthermore, Phα1β (30-300pmol/site, i.t.) elicited less adverse effects than ω-conotoxin MVIIA (10-300 pmol/site, i.t.). Taken together, our data evidence the involvement of N-type VGCC in pain sensitization induced by paclitaxel and point out the potential of Phα1β as a safer alternative than ω-conotoxin MVIIA to treat the pain related to paclitaxel.