Gastrointestinal Pain Research Articles

Impact of light quality on flavonoid production and growth of Hyptis marrubioides seedlings cultivated in vitro

Hyptis marrubioides Epling, Lamiaceae, a species from Brazilian Cerrado, has been used against gastrointestinal infections, skin infections, pain, and cramps. Herein, H. marrubioides seedlings were cultured in vitro under different wavelengths (white, blue, green, red, and yellow) with 50μmolm−2s−1 irradiance and a 16-h photoperiod. After 20 and 30 days of cultivation, shoot length, leaf number, fresh mass, and dry mass were evaluated. The flavonoid rutin content was determined by the HPLC-DAD method. The shoots were longer in plants cultivated under yellow (16.603±0.790cm, 1.8-fold), red (15.465±0.461cm, 1.7-fold), and green (14.677±0.737cm, 1.6-fold) lights than in control plants exposed to white light (9.203±0.388cm). The number of leaves increased in plants exposed to red (23.425±1.138, 1.1-fold) and green (22.725±1.814, 1.1-fold) lights, compared to control plants (20.133±0.827). Fresh (0.665±0.048g, 1.2-fold) and dry (0.066±0.005g, 1.3-fold) mass of seedlings were the highest in seedlings grown under red light, compared to seedlings grown under white light (0.553±0.048 and 0.028±0.004, respectively). However, rutin production was higher under white (0.308mgg−1 of dry weight) and blue lights (0.298mgg−1 of dry weight). Thus, red light induces plant growth and increases leaf number and dry weight in in vitro-cultivated H. marrubioides, whereas blue and white lights promote the greatest rutin accumulation.

Biased Signaling by Agonists of Protease Activated Receptor 2.

Protease activated receptor 2 (PAR2) is associated with metabolism, obesity, inflammatory, respiratory and gastrointestinal disorders, pain, cancer, and other diseases. The extracellular N-terminus of PAR2 is a common target for multiple proteases, which cleave it at different sites to generate different N-termini that activate different PAR2-mediated intracellular signaling pathways. There are no synthetic PAR2 ligands that reproduce the same signaling profiles and potencies as proteases. Structure-activity relationships here for 26 compounds spanned a signaling bias over 3 log units, culminating in three small ligands as biased agonist tools for interrogating PAR2 functions. DF253 (2f-LAAAAI-NH2) triggered PAR2-mediated calcium release (EC50 2 μM) but not ERK1/2 phosphorylation (EC50 > 100 μM) in CHO cells transfected with hPAR2. AY77 (Isox-Cha-Chg-NH2) was a more potent calcium-biased agonist (EC50 40 nM, Ca2+; EC50 2 μM, ERK1/2), while its analogue AY254 (Isox-Cha-Chg-A-R-NH2) was an ERK-biased agonist (EC50 2 nM, ERK1/2; EC50 80 nM, Ca2+). Signaling bias led to different functional responses in human colorectal carcinoma cells (HT29). AY254, but not AY77 or DF253, attenuated cytokine-induced caspase 3/8 activation, promoted scratch-wound healing, and induced IL-8 secretion, all via PAR2-ERK1/2 signaling. Different ligand components were responsible for different PAR2 signaling and functions, clues that can potentially lead to drugs that modulate different pathway-selective cellular and physiological responses.

Pain management in the Ehlers-Danlos syndromes.

Chronic pain in the Ehlers-Danlos syndromes (EDS) is common and may be severe. According to one study, nearly 90% of patients report some form of chronic pain. Pain, which is often one of the first symptoms to occur, may be widespread or localized to one region such as an arm or a leg. Studies on treatment modalities are few and insufficient to guide management. The following is a discussion of the evidence regarding the underlying mechanisms of pain in EDS. The causes of pain in this condition are multifactorial and include joint subluxations and dislocations, previous surgery, muscle weakness, proprioceptive disorders, and vertebral instability. Affected persons may also present with generalized body pain, fatigue, headaches, gastrointestinal pain, temporomandibular joint pain, dysmenorrhea, and vulvodynia. Pain management strategies may be focused around treating the cause of the pain (e.g., dislocation of a joint, proprioceptive disorder) and minimizing the sensation of pain. Management strategies for chronic pain in EDS includes physical therapy, medications, as well as durable medical equipment such as cushions, compressive garments, and braces. The different modalities are discussed in this paper. © 2017 Wiley Periodicals, Inc.

Chronic Gastrointestinal Dysmotility and Pain Following Total Pancreatectomy with Islet Autotransplantation for Chronic Pancreatitis

BackgroundThe prevalence and impact of chronic gastrointestinal dysmotility following total pancreactectomy with islet autotransplantation (TP-IAT) for chronic pancreatitis is not known. MethodsA cross-sectional study of all patients who underwent TP-IAT at our institution from August 2011 to November 2015 was undertaken. The GCSI (Gastroparesis Cardinal Symptom Index), PAGI-SYM (Patient Assessment of Upper Gastrointestinal Disorders-Symptom Severity Index), PAC-SYM (Patient Assessment of Constipation Symptoms), Bristol stool chart, 12-item Short Form Health Survey (SF-12), and visual analog scale for pain were administered ≥4 weeks following TP-IAT. Key ResultsThe prevalence of any dysmotility symptoms in patients who completed the survey (33/45, 73%) post-TP-IAT was 45%. Post-TP-IAT, the mean reduction in opioid dosing was 77.6 oral morphine equivalents (OMEs) (95% CI 32.1–123.0, p = 0.002) with 42% of patients requiring no opioids. There was significant negative correlation between dysmotility scores and SF-12 physical scores (r = −0.46, p = 0.008, 95% CI −0.70 to −0.13). Self-reported abdominal pain had significant negative correlation with both physical and mental SF-12 scores (r = −0.67, p < 0.001, 95% CI −0.83 to −0.41 and r = −0.39, p = 0.03, 95% CI −0.65 to −0.04). There was no correlation between gastrointestinal dysmotility and self-reported pain. Conclusions and InferencesSymptoms of chronic gastrointestinal dysmotility and chronic abdominal pain are common post-TP-IAT and will need to be better recognized and differentiated to improve the management of these patients.

Results of a Qualitative Study to Develop a Patient Reported Outcome Measure for Patients with 4 Subtypes of Soft Tissue Sarcoma.

Objective The objective of this research was to develop a disease-specific symptom inventory for soft tissue sarcoma. Methods Literature review and clinical expert and patient interviews were conducted to determine disease-specific symptoms important to patients with one of the four STS subtypes. Clinical experts identified the most relevant STS symptom items from the item pool developed from literature review. Concept elicitation interviews were conducted with patients to elicit their STS symptom experiences followed by a completion of the draft symptom list via web survey. A cognitive interview was conducted on the comprehension and importance of the symptom items. Results Eighty-three symptom items were compiled and discussed with three clinical experts who identified 26 symptoms specific to the four STS subtypes. A total sample of 27 STS participants with self-reported leiomyosarcoma (74%), undifferentiated sarcoma (15%), synovial sarcoma (7%), or liposarcoma (4%) diagnosis completed the web survey and 10 were interviewed. The draft 12-item STS-specific symptom inventory includes abdominal pain, pressure in abdomen, early satiety, bloating, gastrointestinal pain, muscle pain, bone pain, heavy menstrual flow, shortness of breath, chest pain, cough, and painful menstruation. Conclusion A number of symptoms are common across STS subtypes and may form a single STS symptom inventory.

Gastrointestinal stromal tumour of the jejunum in an elderly female patient with atypical symptomatology

Gastrointestinal stromal tumour (GIST) neoplasms are rare malignancies of the gastrointestinal tract. Most commonly they present with gastrointestinal bleeding and abdominal pain as the main symptoms. Here we present the case of a 52-year-old Greek female patient with GIST neoplasm of the jejunum, who attended the Emergency Department of our Hospital with indigestion and abdominal distention as the only symptoms. This is, to our knowledge, the second GIST tumour of the jejunum ever reported in Greece and the first with atypical symptomatology.

Neurobiological Mechanism of Acupuncture for Relieving Visceral Pain of Gastrointestinal Origin.

It is currently accepted that the neural transduction pathways of gastrointestinal (GI) visceral pain include the peripheral and central pathways. Existing research on the neurological mechanism of electroacupuncture (EA) in the treatment of GI visceral pain has primarily been concerned with the regulation of relevant transduction pathways. The generation of pain involves a series of processes, including energy transduction of stimulatory signals in the sensory nerve endings (signal transduction), subsequent conduction in primary afferent nerve fibers of dorsal root ganglia, and transmission to spinal dorsal horn neurons, the ascending transmission of sensory signals in the central nervous system, and the processing of sensory signals in the cerebral cortex. Numerous peripheral neurotransmitters, neuropeptides, and cytokines participate in the analgesic process of EA in visceral pain. Although EA has excellent efficacy in the treatment of GI visceral pain, the pathogenesis of the disease and the analgesic mechanism of the treatment have not been elucidated. In recent years, research has examined the pathogenesis of GI visceral pain and its influencing factors and has explored the neural transduction pathways of this disease.

Cav2.2 and Cav3.1 calcium channel inhibitors from Valeriana jatamansi Jones

In China, the roots and rhizomes of Valeriana jatamansi Jones are traditionally used to treat gastrointestinal and rheumatic pain. In the present study, a number of N- and T-type calcium channel inhibitors were initially isolated and identified.

Effect of traditional Chinese medicine-based nursing intervention on gastrointestinal function, psychological mood, and pain in patients after surgery for lumbar disc herniation

Effect of traditional Chinese medicine-based nursing intervention on gastrointestinal function, psychological mood, and pain in patients after surgery for lumbar disc herniation

Nonmotor Features in Atypical Parkinsonism.

Atypical parkinsonism (AP) comprises mainly multiple system atrophy (MSA), progressive supranuclear palsy (PSP), and corticobasal degeneration (CBD), which are distinct pathological entities, presenting with a wide phenotypic spectrum. The classic syndromes are now called MSA-parkinsonism (MSA-P), MSA-cerebellar type (MSA-C), Richardson's syndrome, and corticobasal syndrome. Nonmotor features in AP have been recognized almost since the initial description of these disorders; however, research has been limited. Autonomic dysfunction is the most prominent nonmotor feature of MSA, but also gastrointestinal symptoms, sleep dysfunction, and pain, can be a feature. In PSP and CBD, the most prominent nonmotor symptoms comprise those deriving from the cognitive/neuropsychiatric domain. Apart from assisting the clinician in the differential diagnosis with Parkinson's disease, nonmotor features in AP have a big impact on quality of life and prognosis of AP and their treatment poses a major challenge for clinicians.

The effect of mad honey on testosterone levels of male rats.

We aimed to investigate the effect of mad honey on sexual performance. In traditional medicine in Turkey, mad honey is used to improve appetite, to heighten mental alertness, to reduce joint pain, to eliminate gastrointestinal system pains and to increase sexual performance. In this experimental animal study eighteen Sprague Dawley male rats were randomized into three groups, a control group, a normal honey group and a mad honey group. Rats in the treatment groups were given a daily dose of 80 mg/kg normal honey or mad honey throughout the 30-day study period. Total testosterone, free testosterone, FSH, LH, estradiol, and progesterone levels were subsequently investigated from blood sera on day 30. Comparison of blood total testosterone levels among the groups revealed significantly higher levels in the mad honey group compared to the normal honey and control groups (p = 0.006, p = 0.00). Free testosterone levels were also significantly higher in the mad honey group than in the normal honey and control groups (p = 0.023, p = 0.01). No statistically significant differences were determined for other hormonal measurements. This study revealed a significant increase in both total and free testosterone levels in mad-honey group (Tab. 1, Fig. 2, Ref. 16).

Effect of PDCA intervention on compliance of patients receiving oral analgesic medication for gastrointestinal cancer pain

Effect of PDCA intervention on compliance of patients receiving oral analgesic medication for gastrointestinal cancer pain

5-HT secretion by enterochromaffin cells is a very touching story.

Gastrointestinal (GI) function is controlled by sympathetic, parasympathetic, sensory and enteric nerves. In addition, the gut mucosa contains enteroendocrine cells which release hormones and paracrine signalling molecules in response to chemical and mechanical stimulation by GI luminal content. Enterochromaffin (EC) cells are an enteroendocrine cell type in the gut mucosa. EC cells release 5-hydroxytryptamine (5-HT) in response to mechanical and chemical stimuli. 5-HT released from EC cells stimulates intestinal motor and secretomotor reflexes by activating 5-HT receptors on terminals of intrinsic primary afferent neurons (IPANS) whose cell bodies are located in the enteric nerve plexuses. IPANS synapse with interneurons which excite other enteric neurons to initiate reflex responses. EC cell-derived 5-HT also acts at 5-HT receptors on extrinsic sensory nerve terminals to convey nociceptive signals to the CNS (via spinal afferents) or to initiate GI reflexes via vagal afferents. TRPA1 channels are chemosensitive ion channels expressed by EC cells and TRPA1 stimulants cause 5-HT release from EC cells (Nowaza et al. 2009). EC cells are also activated by mechanical stimulation and EC cells express unidentified mechanosensitive proteins. The paper by Wang et al. (2017) in this issue of The Journal of Physiology provides exciting new data indicating that Piezo2 is a mechanosensitive ion channel expressed by EC cells. Piezo2 is one of two Piezo ion channels (Piezo1 and Piezo2) expressed by proprioceptive cells (Woo et al. 2015). Piezo2 was also shown to be important for mechanosensation by Aβ nerve fibres that together with Merkel cells (Merkel-cell–neurite complexes) are involved in light touch sensation (Ranade et al. 2014). Piezo channels are large proteins (∼2600 amino acids) and the murine Piezo1 channel has 14 transmembrane spanning domains (Ge et al. 2015). Human Piezo2 has a single channel conductance of ∼26 pS and the channel inactivates during continuous mechanical stimulation of the cell. Piezo2 is a non-selective cation channel (Irev = ∼0 mV) with a rank order permeability of Ca2+ > Na+ > K+. The high Ca2+ permeability may be particularly important for EC cell 5-HT release. Wang and co-workers provide immunohistochemical data showing Piezo2 co-localized with 5-HT in EC cells in the human jejunum. Piezo2 was also co-expressed in EC cells in the small intestine of transgenic mice where cyano-fluorescent protein (CFP) expression was driven by the tryptophan hydroxylase-1 (TpH-1) promoter. TpH-1 is the rate limiting enzyme in the 5-HT biosynthetic pathway in EC cells. Piezo2 also co-localized with TpH-1 cells in the mucosa of the mouse jejunum. Wang and colleagues (2017) used QGP-1 cells (an EC cell line) to study mechanically activated inward currents. Mechanical stimulation of QGP-1 cells produced a stimulus intensity-related and rapidly inactivating (≤10 ms) inward current that had a reversal potential near 0 mV. These data suggest that Piezo2 in EC cells is a non-selective cation channel. Mechanically activated currents and 5-HT release from QGP-1 cells were inhibited by Piezo2 siRNA knockdown and by the Piezo2 blockers, Gd3+ and Ruthenium Red and by D-GsMTx4, a mechanosensitive ion channel blocker. The contribution of Piezo2 to intestinal function was assessed using Ussing chambers to measure short circuit currents (ISC) across full thickness preparations of mouse jejunum. Pressure applied to the mucosa evoked an increase in ISC and 5-HT release. These responses were inhibited by mucosally applied Gd3+, Ruthenium Red and GsMTX4, suggesting that Piezo2 blockers act directly on EC cells. Previous ultrastructural studies in the mouse duodenum revealed close appositions between the basolateral surface of EC cells and nerve fibres (Wade & Westfall, 1985) These subepithelial nerve fibres could be targets for 5-HT released from EC cells. Wang et al. (2017) found that the 5-HT3 and 5-HT4 receptor antagonists ondansetron and GR 113808 blocked pressure-evoked ISC when the drugs were applied to the basolateral (serosal) but not mucosal surface of the tissue. It is possible that 5-HT diffuses (at least in ex vivo preparations) to the nerve plexuses to activate secretomotor circuits. However, these data do not yet rule out the possibility of direct subepithelial nerve fibre activation by EC cell 5-HT. 5-HT released from EC cells participates in several physiological (gut secretion, for example) and pathophysiological (GI pain) responses in the gut. The irritable bowel syndrome (IBS) is a gastrointestinal motility/sensation disorder in which EC cell 5-HT release is a key player. Intestinal Piezo2 might be a target for new drugs that could treat IBS or other disorders associated with excessive 5-HT release from EC cells. The author has no conflicts to disclose.

Epidural Local Anesthetics Versus Opioid-Based Analgesic Regimens for Postoperative Gastrointestinal Paralysis, Vomiting, and Pain After Abdominal Surgery: A Cochrane Review.

The aim of this review was to compare the effects of postoperative epidural analgesia with local anesthetics to postoperative systemic or epidural opioids in terms of return of gastrointestinal transit, postoperative pain control, postoperative vomiting, incidence of gastrointestinal anastomotic leak, hospital length of stay, and cost after abdominal surgery. Trials were identified by computerized searches of the Cochrane Central Register of Controlled Trials (CENTRAL) (2014, Issue 12), Medical Literature Analysis and Retrieval System Online (MEDLINE) (from 1950 to December, 2014) and Excerpta Medica dataBASE (EMBASE) (from 1974 to December 2014) and by checking the reference lists of trials retained. We included parallel randomized controlled trials comparing the effects of postoperative epidural local anesthetic with regimens based on systemic or epidural opioids. The quality of the studies was rated according to the Cochrane tool. Two authors independently extracted data. We judged the quality of evidence according to the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) working group scale. Based on 22 trials including 1138 participants, an epidural containing a local anesthetic will decrease the time required for return of gastrointestinal transit as measured by time required to observe the first flatus after an abdominal surgery standardized mean difference (SMD) -1.28 (95% confidence interval [CI], -1.71 to -0.86; high quality of evidence; equivalent to 17.5 hours). The effect is proportional to the concentration of local anesthetic used. Based on 28 trials including 1559 participants, we also found a decrease in time to first feces (stool): SMD -0.67 (95% CI, -0.86 to -0.47; low quality of evidence; equivalent to 22 hours). Based on 35 trials including 2731 participants, pain on movement at 24 hours after surgery is also reduced: SMD -0.89 (95% CI, -1.08 to -0.70; moderate quality of evidence; equivalent to 2.5 on a scale from 0 to 10). Based on 22 trials including 1154 participants, we did not find a difference in the incidence of vomiting within 24 hours: risk ratio 0.84 (95% CI, 0.57-1.23); low quality of evidence. Based on 17 trials including 848 participants we did not find a difference in the incidence of gastrointestinal anastomotic leak: risk ratio 0.74 (95% CI, 0.41-1.32; low quality of evidence). Based on 30 trials including 2598 participants, epidural analgesia reduces length of hospital stay for an open surgery: SMD -0.20 (95% CI, -0.35 to -0.04; very low quality of evidence; equivalent to 1 day). Data on cost were very limited. An epidural containing a local anesthetic, with or without the addition of an opioid, accelerates the return of the gastrointestinal transit (high quality of evidence). An epidural containing a local anesthetic with an opioid decreases pain after an abdominal surgery (moderate quality of evidence). An epidural containing a local anesthetic does not affect the incidence of vomiting or anastomotic leak (low quality of evidence). For an open surgery, an epidural containing a local anesthetic would reduce the length of hospital stay (very low quality of evidence).

Efficacy and safety of angiogenesis inhibitors in small-cell lung cancer

ObjectiveThe purpose of this study was to investigate the efficacy and safety of angiogenesis inhibitors for small-cell lung cancer (SCLC).MethodsTotally, 16 controlled trials (1898 cases) involving angiogenesis inhibitors plus chemotherapy (ACT group) versus chemotherapy alone group (CT group) were identified from PubMed, EMBASE, Cochrane Library and Wanfang Data before March 2016.ResultsCompared with CT group, ACT group obtained a significant benefit on objective response rate (ORR) (RR = 1.34; 95% CI = 1.19-1.51; P < 0.00001) and a trend of prolonging progression-free survival (PFS) (HR = 0.86; 95% CI = 0.73-1.01; P = 0.07) without improving overall survival (OS) (HR = 1.05; 95% CI = 0.94-1.17; P = 0.36). Remarkably, subgroup analysis showed that the antibodies targeting VEGF significantly prolonged PFS (HR = 0.76; 95% CI = 0.64-0.90; P = 0.001). With regard to toxicity, there was no significant difference in severe adverse events (AEs, Grade≥3) between two groups except that gastrointestinal symptom, hypertension, metabolic disorders, neurology and pain were higher in ACT group.ConclusionCompared with chemotherapy alone, antibodies targeting VEGF plus chemotherapy significantly improved ORR and prolonged PFS with an acceptable toxicity profile for patients with SCLC. Therefore, angiogenesis inhibitors, especially antibodies targeting VEGF, combining with chemotherapy may be a potential promising strategy in managing SCLC.

Bleeding gastrointestinal stromal tumour of the stomach complicated by massive deep vein thrombosis – a management ilemma – a case report

Cancer is a major risk factor for venous thromboembolism (VTE). Its treatment is an added risk factor for VTE. Malignancy results in a hypercoagulable state and hence DVT requiring anticoagulation. Cancer patients are at high risk of anticoagulant associated bleeding. Bleeding complications occur more with unfractionated heparin as compared to low molecular weight heparin. Standard medical treatment based on vitamin K antagonists is less effective and is associated with increased risk of bleeding in cancer patients. Low molecular weight heparin treatment has added advantages such as less sensitivity to drug interactions, lack of need for regular monitoring and has no problem of narrow therapeutic window as opposed to warfarin. Gastrointestinal stromal tumours (GIST) are the most common mesenchymal tumours of the gastrointestinal tract. The most common presentation is of gastrointestinal bleeding, pain and/or dyspepsia. We report the case of a 67 year old hypertensive female patient who presented with a history of massive haematemesis and malaena. Upper gastrointestinal endoscopy confirmed a gastric tumour. She developed massive sudden swelling of the left lower limb whilst awaiting surgery. Doppler ultrasound scan confirmed an iliofemoral deep vein thrombosis (DVT). Inferior vena cava filter insertion was not possible due to non-availability. Coexistence of DVT needing anticoagulation and bleeding gastric GIST requiring urgent resection presented a management dilemna. Despite the risk, the patient was taken for an emergency tumor resection primarily to stop the bleeding and facilitate full anticoagulation therapy more safely. After 24 months follow up the patient had no evidence of recurrence of both the GIST and DVT. Keywords : deep vein thrombosis, venous thromboembolism upper gastrointestinal bleeding, gastric tumour

The Pain of Pyloric Stenosis

There are approximately 6,000,000 annual visits to the ED for chest pain in the US. However, only up to 30% of these patients have acute coronary syndromes. Other sources of chest pain can include vascular, pulmonary or gastrointestinal etiologies. Pyloric stenosis is one cause of gastrointestinal chest pain. H. pylori induced peptic ulcers are a known cause of pyloric stenosis. However, these secondary ulcers generally resolve with standard antimicrobial therapy. As a result, gastric outlet obstruction due to H. pylori induced pyloric stenosis is extremely rare. A 62 year old Hispanic male with a history of smoking presented with 3/10 chest tightness that was intermittent, sub-sternal and radiated to the right shoulder and back. It was associated with dyspnea and diaphoresis and exacerbated by oral intake. Additionally, he complained of right upper quadrant burning, vomiting after oral intake and a 30 lb weight loss over 4 months. Due to the presence of alarm symptoms a life threatening coronary syndrome was ruled out. Concomitant gastrointestinal evaluation showed dilation of the pancreatic duct on ultrasound. MRCP confirmed biliary and pancreatic ductal dilation with no clear etiology. Interestingly, an ERCP was unsuccessful due to severe pyloric stenosis. Subsequent upper endoscopy visualized severe gastritis in the antrum, body, and fundus of the stomach (Figure 1). A single ulcer was noted on the pylorus (Figure 2). The esophagus and stomach were dilated. Biopsy specimens showed active chronic gastritis with erosion and focal intestinal metaplasia. Presence of H. pylori was confirmed by immunohistochemistry (Figure 3). A gastric emptying study showed delayed emptying with reflux. The patient was managed with a standard triple therapy regimen. Although our patient presented with pain suspicious of cardiac origins, his true diagnosis was adult onset pyloric stenosis. An overlap in presentation can be seen in cardiac and gastrointestinal etiologies due to their anatomic proximity. A lack of accessibility to medical care resulted in our patients gastritis never being treated. It subsequently progressed, leading to ulceration which induced pyloric stenosis causing gastric outlet obstruction. As evidenced by this case, a high degree of suspicion must be maintained for gastrointestinal causes in patients presenting with non-cardiac chest pain.Figure 1Figure 2Figure 3

Common functional pain syndromes

### Key points When a patient presents with pain of no obvious organic origin, they are often labelled as having ‘functional’ pain. The exact diagnosis is derived from the organ system displaying the predominant symptoms e.g. musculoskeletal pain in fibromyalgia (FM) or visceral pain in irritable bowel syndrome (IBS). The worldwide prevalence of all functional pain syndromes (FPS) is 15–20%. World Health Organization (WHO) surveys reveal that ∼10% of primary care patients develop a chronic pain condition within 12 months of initial registration. Of these, at least 50% continue to have symptoms beyond 1 yr. FPS cause enormous economic burden on society with concurrent ramifications for the individual's family in particular and society in general. FM alone has been estimated to cost around £4000 per patient per year. There has been a paradigm shift in the understanding of FPS. The old model of multiple discrete chronic pain conditions is being replaced by a more overarching, although no less complex, state of central sensitivity syndrome (CSS). Evidence is being accrued that FPS represent the phenotypic output of a complex interplay between genetic susceptibility, gene–environment interactions, and environmental triggers. Four common FPS will be reviewed in this article: FM, IBS, temporomandibular dysfunction (TMD), and chronic cardiac chest pain (CCCP). The pathophysiology and management of each will be examined and the case presented for a shared underlying mechanism called CSS. Once this new mechanism is adopted more widely, it will allow for future novel management options to be …

The Addition of Dexmedetomidine to Analgesia for Patients After Abdominal Operations: A Prospective Randomized Clinical Trial.

Postoperative pain and anxiety are two common factors influencing patient's recovery. Benefits and safety in the use of sedative agents after abdominal operations to improve recovery are not well known. The present study is to evaluate the efficacy and safety of dexmedetomidine use in this population. A prospective randomized controlled trial of 145 patients undergoing abdominal operations was conducted in the Surgical Intensive Care Unit of Jinling Hospital between October and December 2015. Thirty-two patients were excluded, and 113 were included and divided into the experimental group (59 patients) receiving dexmedetomidine and analgesics for 72h after abdominal operations, and the control group (54 patients) receiving only analgesics. Postoperative pain, inflammatory response, recovery of gastrointestinal function, adverse events, and sedation level were analyzed. Pain scores, assessed by Prince Henry Pain Scale (PHPS), in the experimental group were significantly lower than in the control group on the first (1.53 vs. 2.07, p≤0.01), second (1.07 vs. 1.63, p≤0.01), and third day (1.08 vs. 1.82, p=0.01). Time to defecation was 0.60days shorter in the experimental group than the control group (2.51 vs. 3.11, p=0.01). There was no significant difference between inflammatory responses in the two groups (p>0.05). Both groups had similar blood pressure, heart rate, prevalence of bradycardia, and hypotension requiring interventions (p>0.05). The addition of dexmedetomidine to analgesia after abdominal operations is safe and could enhance gastrointestinal function recovery and pain control when monitored carefully. The capacity of dexmedetomidine to attenuate inflammatory responses requires further investigation.

Review on Clinical Studies of Traditional Herbal M edicine and Acupuncture Treatments for Colorectal Cancer Patients

The aim of this study was to collect and analyze the clinical studies of traditional herbal medicine and acupuncture treatments for colorectal cancer patients searched in Pubmed and Cochrane library in English. We collected the clinical studies, including randomized controlled trial, case control study and cohort study, in the PubMed and Cochrane library using keywords ‘Colorectal Cancer’, ‘Korean Medicine’, ‘Traditional Chinese Medicine’, ‘Kampo’ and ‘Acupuncture’. Then we analyzed them according to the objective of the therapy, i.e. improving therapy prognosis, reducing chemotherapy’s adverse event and reducing operational adverse event. In case RCT, we evaluate the quality of the study with jadad scale. Total 18 studies were selected. There were 3 studies about improving therapy prognosis, 6 studies about reducing chemotherapy’s adverse event and 9 studies about reducing operational adverse event. Traditional medicine might improve therapy prognosis in terms of the survival rate, relapse/metastasis rate, quality of life and immune function. The specific herbal formula, ‘Goshajinkigan’ might not be successful about reducing chemotherapy’s adverse event, peripheral neurotoxicity. ‘Hangeshanshinto’ might reduce the duration of oral mucositis but it is not clear to reduce the incidence of that. ‘PHY906’ might reduce the incidence of diarrhea. Acupuncture might reduce operational adverse event such as gastrointestinal dysfunction and pain. And ‘Daikenchuto’ might not be successful in reducing operational adverse event, gastrointestinal dysfunction. Further studies are needed to clarify the efficacy of traditional herbal medicine and acupuncture for colorectal cancer patients.