Neuropatic Pain Research Articles

DESCRIPTION OF PAIN IN DIABETES MELLITUS AND NON-DIABETES MELLITUS PATIENTS AT PUSKESMAS DANUREJAN 1, YOGYAKARTA

<p><strong>Background</strong> Diabetes mellitus (DM) is a disease caused by impaired glucose metabolism, failure of the pancreas to produce the insulin hormone or the body's inability to respond to the insulin hormone. The neurologic complications are neuropathic or nociceptive pain. Neuropathic pain can cause the decrease in patient’s quality of life. Knowing the spread of neuropathic pain based on anatomical predilection may help clinicians conduct early diagnosis and improve the patient's quality of life.</p><p><strong>Objective</strong> This study aim to determine the characteristics, prevalence and location of pain in patients with type 2 diabetes mellitus and non-diabetes mellitus at Puskesmas Danurejan I Yogyakarta.</p><p><strong>Methods</strong> A descriptive quantitative study on 42 secondary data from previous study in Puskesmas Danurejan I. The inclusion criteria were data of patients with neuropathic pain (electric shock-like pain, stabbing pain) and nociceptive pain (burning sensation pain) who were > 40 years old. The exclusion criteria were incomplete data and recorded consumed non-steroidal anti-inflammatory drugs in the last of 4 days in previous study. Univariate and bivariate analysis were used in this study.</p><p><strong>Results</strong> Patients with DM accounted for 50% of cases by 21 people. Patients with DM had the most frequent comorbidities, such as hypertension (42.8%) and obesity (42.8%), Most patients with DM reported pain (85.7%) with neuropathic back pain (27.7%). Based on the type of pain, patients with DM most frequently reported neuropathic pain (66.7%) (p=0.001).</p><p><strong>Conclusion</strong> There was a relationship between diabetes mellitus and the incidence of neuropatic pain but not nociceptive pain.</p>

Incidence of chronic neuropatic pain after open heart surgery: A retrospective cohort analysis

Incidence of chronic neuropatic pain after open heart surgery: A retrospective cohort analysis

Efficacy of intravenous alpha lipoic acid in the treatment of neuropatic pain due to carpal tunnel syndrome.

<p>In this study, we analyzed the effect of oral and oral + intravenous Alpha-lipoic acid (ALA) treatment on pain level and physical examination findings in patients diagnosed with carpal tunnel syndrome (CTS).</p>. <p>A total of 115 patients patricipa&shy;ted in the study. Physiotherapy and wrist splint were first applied to all patients diag&shy;nosed with CTS in the study. 40 patients were treated with oral ALA after iv. ALA the&shy;rapy, 35 patients received only oral ALA treatment and 40 patients did not receive any medication. The patients were divided into 3 groups as those who received only splint treatment and physiotherapy, those who received oral ALA treatment, and those who received oral ALA treatment after iv. treat&shy;ment. All patients were assessed be&shy;fore the treatment, and at the 1st and 3rd months of the treatment. In clinical assessment, visual analog scale (VAS) forms were filled to define the pain severity, the Boston symptom severity scale (BSSS) and Boston functional status scale (BFDS) were filled for evaluating symptoms and functional status.&nbsp;</p>. <p>VAS, BSSS and BFDS scores of the patients who were treated with intravenous and then oral ALA were found to be significantly lower at the end of both the 1st and 3rd months compared to the patients who received only oral ALA or no medication (p=0.001; p&lt;0.001), (p=0.001; p&lt;0.001), (p=0.006; p&lt;0.001).</p>. <p>We think that iv. ALA is effective in the treatment of symptoms associated with CTS.</p> <p>&nbsp;</p>.

Percutaneous lumbar interbody fusion and Cortoss cement bone augmentation in osteoporotic patients with anterolisthesis: A technical note

To describe the technique of bone augmentation using Cortoss cement, in patients with osteoporosis and spondylolisthesis, eligible to posterior stabilization with rods and screws.In this technical note it is described the treatment of spondylolisthesis, up to grade 2, with associated foraminal stenosis or central stenosis, resistant to medical therapy and physiotherapy, in patients with osteopenic/osteoporotic who needs.Pre-operative MOC-DEXA, X-rays, and MRI have to be performed in order to plan.Post-operative imaging was performed with CT ad X-rays.The outcome was assessed using the VAS score, the Oswestry Disability Index and Neuropatic Pain in 4 Questions (NPSI) at a 1,6 and 12 months follow-up and also includedx-rays and CT-scan with volume rendering reconstruction to evaluate the correct bone fusion and the absence of complications.Operation time was 142 min and mean postoperative time until hospital discharge was 2 days. Postoperative values for VAS scores, ODI and NPSI improved significantly compared to pre-operative data. No postprocedural sequelae were observed.This report shows a feasible and safe full percutaneous alternative procedure and represents a minimally invasive management of spondylolisthesis, up to grade 2, with stenosis of vertebral canal and low back pain resistant to medical therapy, even in patients with osteopenia/osteoporosis.

Evaluation of Neuropatic Pain Features in COVID-19 Patients.

Pain is a common complaint in COVID-19 disease. Neurotrophic features of the COVID virus are reported. Neuropathic pain is seen during many viral infections and observed during the COVID-19 pandemic part of the clinical presentations. The aim of this is to evaluate neuroptic pain as presenting symptom in COVID-19 patients. In this cross-sectional descriptive study, adult patients (18 years and older) who applied to the COVID Outpatient Clinic completed the demographic data form and the neuropathic pain questionnaire. The patients were divided into positive and negative according to the PCR test results and the presence of neuropathic pain was compared. In total, 440 participants included in the study. Among 301 who stated to had any complaints, 197 (65.4%) had pain. The intensity of their pain was 5.8 ± 2.4 (0 - no pain and 10 - the most severe pain of life). Neuropathic pain component was present in 29.2% of the patients. Among the first admissions, neuropathic pain component was observed significantly higher in those with positive PCR test (55.0%) than negative ones (23.8%), and the Odd's ratio was calculated as 3.911. COVID-19 virus is thought to have neuroinvasion and neurotropic effects. In this study, neuropathic pain specifically was evaluated in COVID-19 patients, and the frequency of neuropathic pain was significantly higher in PCR confirmed COVID-19 patients at the onset of the disease.

Evaluation of Knowledge and Attitudes About The Traditional and Complementary Medicine Practices of the Patients with Neuropatic Pain Who Applied to the Physıcal Medicine and Rehabilitation Clinic

Objective: To evaluate the frequency of traditional and complementary medicine (TCM) use, the variety of applications, the sociodemographic and clinical characteristics of patients with neuropathic pain, and their knowledge and attitudes about TCM practices.Material and Methods: A total of 250 patients with neuropathic pain were included in this, cross-sectional study. The patients were divided into two groups: medication only (group 1, n=119) and medication with TCM practices (group 2, n=131). Questionnaires were completed by the patients in face-to-face interviews by a blinded physician.Results: The mean age of the patients in group 2 (50.68±16.39) was found to be higher than in group 1 (p=0.043). In terms of chronic diseases, hypertension, cardiovascular diseases, and other diseases were found to be more common in group 2 than in group 1 (p&amp;lt;0.05). The number of patients with duration of neuropathic pain more than 5 years, the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) pain scale and the Neuropathic Pain 4 (DN4) scale scores were found to be higher in group 2 than in group 1 (p&amp;lt;0.05). At least one TCM is known by %78.6 of group 2 and 61.3% of group 1 (p=0.003). The three most commonly used TCM practice in group 2 were wet cupping/cupping therapy (24%), leeches (22.8%), and acupuncture (11.6%).Conclusion: It was determined that the mean age of patients who used medication with TCM practices together for the treatment of neuropathic pain was higher, neuropathic pain severity was higher, and neuropathic pain duration was longer than patients who used medication only for the treatment of neuropathic pain.

Neuropathic pain in ankylosing spondylitis: ameta-analysis.

The aim of this study was to compare demographic characteristics, disease activity, functional status, and quality of life between ankylosing spondylitis (AS) with neuropatic pain (NP) and AS without NP (Non-NP). The MEDLINE via PubMed, Cochrane, Scopus, and Embase database, from the earliest available date of indexing through December20, 2018, were searched for comparative studies evaluating NP in AS patients. Two authors performed the data extraction independently. Any discrepancies were resolved by consensus. Four comparative studies were identified. There was no statistically significant difference in terms of age, body mass index, symptom duration, and inflammatory markers, such as erythrocyte sedimentation rate and C‑reactive protein between NP and Non-NP. The sex ratios (F/M) were approximately 1/1 in NP and 1/2 in Non-NP and the proportion of human leukocyte antigen (HLA) B27-positive patients in NP and Non-NP was 65.7% and 83.0%, respectively. NP patients had significantly higher visual analogue scale pain scores, higher Bath Ankylosing Spondylitis Disease Activity Index, higher Bath Ankylosing Spondylitis Functional Index, and lower SF-Item Short Form physical component scores compare to Non-NP patients. The current meta-analysis showed that NP patients had significantly higher pain severity, higher disease activity and lower quality of life than Non-NP patients. The sex ratio (F/M) and proportion of HLA-B27 positive patients were different between the two groups. Further well-designed studies are needed to substantiate our results.

Computer-Aided Selective Optimization of Side Activities of Talinolol.

Selective optimization of side activities is a valuable source of novel lead structures in drug discovery. In this study, a computer-aided approach was used to deorphanize the pleiotropic cholesterol-lowering effects of the beta-blocker talinolol, which result from the inhibition of the enzyme soluble epoxide hydrolase (sEH). X-ray structure analysis of the sEH in complex with talinolol enables a straightforward optimization of inhibitory potency. The resulting lead structure exhibited in vivo activity in a rat model of diabetic neuropatic pain.

The Effect of Neuropathic Pain Symptoms on Remission in Patients with Early Rheumatoid Arthritis.

The presence of neuropatic pain (NeP) is common in subjects with established Rheumatoid Arthritis (RA), and it can influence the disease remission. These aspects have not been investigated in patients with Early Rheumatoid Arthritis (ERA). To investigate the effect of NeP on the achievement of remission in patients with ERA. The study involved consecutive ERA patients with moderate or high disease activity. The painDETECT Questionnaire (PDQ), the 36-item Short Form Health Survey (SF-36), and the Euro- QoL-5 Dimensions (EQ-5D) were administered to all the patients, and their co-morbidity data were used to calculate their modified Rheumatic Disease Comorbidity Index (mRDCI). After six months' follow-up, the presence or otherwise of NeP in each individual patient was calculated, and whether or not the Boolean remission criteria were satisfied. The study was completed by 115 patients (76% females) whose PDQ scores indicated that 13% had probable NeP. At the end of the follow-up period, 25 patients (21.7%) met the Boolean remission criteria. Logistic regression analysis showed that baseline PDQ scores (p=0.0023) and the mRDCI (p=0.0054) were the strongest predictors of not being in Boolean remission. Only one of the 15 patients with concomitant NeP achieved Boolean remission. The presence of NeP may affect the achievement of remission in ERA patients. The PDQ can be a useful tool to measure central pain sensitisation in such patients.

Photophobia and neuropatic pain in Sudeck´s syndrome

Photophobia and neuropatic pain in Sudeck´s syndrome

Modern view of the pathogenetic mechanisms of the limbic system role in the forming of pain syndromes in pharmacoresistant facial sympathalgia

The present work was devoted to pharmacoresistant facial sympathalgia which held one of the frequent places among other neuropatic acute and chronic pain syndromes; they usually characterized by long-term clinical course and severe pain which is resistant to conducted conservative therapy by several pharmaceutical drugs. In this paper the general modern data about the etiopathogenetic mechanisms and the role of limbic system, its other anatomical and physiological parts in the genesis and forming of pain paroxysms in facial sympathalgia were presented. Pharmacoresistant facial sympathalgia differs from the other pain syndromes with more similar and typical localization, the severity of clinical manifestations, the presence of neurological deficit, long-recurrent clinical course, resistance to various treatment methods, both therapeutic and neurosurgical, and different somatic complications. At the autonomic response disturbances, epileptic or paroxysmal focus plays the leading disorganizing role, located mainly in the medial structures of the limbic-reticular complex. It has been established, that the limited convulsive activity in various structures of the limbic-reticular complex is the pathogenesis basis of non-epileptic or painful paroxysms, which does not reach of the formation of morpho-functional epileptic system because of influence of various stabilizing factors. Also it was discussed that in the pathogenetic mechanisms any changes in the functional state of the pain-sensing nociceptive and antinociceptive systems and leading neurotransmitters have played the certain role in pharmacologically resistant facial sympathalgia where glutamate and aspartate are being modulators of the convulsive and neuroplastic brain activity, directly and indirectly participating in the formation of processes of excitation and pain threshold, different neurotoxic processes.

Frequency and features of the central poststroke pain

BackgroundCentral poststroke pain (CPSP) is often unrecognized in clinical practice, it may aggravate the rehabilitation process and reduce quality of life. AimTo determine the frequency and features of CPSP, as well as to make possible associations of CPSP with sociodemographic and clinical features of subjects with stroke. MethodIn a two-year period 602 patients with previous stroke were consecutively tested. We used three questionnaires for the diagnosis of neuropathic pain (Pain Detect Questionnaire - PD-Q, The Leeds Assessment of Neuropathic Symptoms and Signs - LANSS and Douleur neuropatathique en 4 questions - DN4). ResultsCPSP was present in 12% of our patients with stroke, and usually occurred in the first several months after stroke. It was associated with cortical and thalamic localization of stroke, higher level of functional disability, as well as with younger age. The most important features that distinguish CPSP from other types of pain were presence of allodynia and pricking hypoesthesia, while other neuropathic sensations were common in stroke subjects both with and without CPSP. ConclusionYounger subjects with cortical/thalamic stroke and higher level of disability should be thoroughly examined for the presence of neuropatic pain, since this may highly influence therapeutic strategy and quality of life in these subjects.

Właściwości prozdrowotne pochrzynu (słodkie ziemniaki)

Dioscorea spp., sometimes called yam, is a genus of around 600 species of tuberous climbers. Since ages it has been used as a food source and in the natural medicine. It contains many fitochemical substances: diterpenoids, glycosides, steroids, saponines and sapogenines. Thanks to this it can be used as a medicine in metabolic diseases, such as diabetes, obesity and hypercholesterolemia. Diosgenin present in the plant stimulates differentiation of fatty cells and eliminate ongoing inflammation. Additionaly, it lowers the amount of triglicerydes and LDL, acting positively on the diabetes related dyslipidemia, lowering the glucose level likewise. Antimicrobial action allows yam to be used against infections, with the possibility of it’s being used against HIV infection. Due to anticancer, anti-inflammatory and antioxidant properties of some polysaccharides present in Dioscorea bulbifera it can be helpful in the adjuvant therapy of cervical cancer and in the therapy of either sarcomas or liver cancer. Since years, analgetic and anti-inflammatory effect of Yam has been used in the traditional medicine of Kamerun. Studies performed on mice proved analgetic action of Dioscorea alata against neuropatic pain, as well as pain releated to inflammation, probably by reducing the level of inflammatory mediators. Studies performed on rats revealed positive effect of usage of Dioscorea alata in the condition of low blood estrogen levels, what presented by lowering anxiety levels and action against lowering of the density of bone tissue. It’s administration in postmenopausal women led to increase in blood estron, estradiol and sex hormones binding protein levels. Due to this action it can counteract against adverse changes caused by reduced level of those hormones. Additionaly, surves have shown beneficial influence of yam on the digestive system, by increasing the level of symbiotic bacterial flora and reducing vulnerability to the toxic effect of lipopolysaccharide.

Glial cell type-specific changes in spinal dipeptidyl peptidase 4 expression and effects of its inhibitors in inflammatory and neuropatic pain

Altered pain sensations such as hyperalgesia and allodynia are characteristic features of various pain states, and remain difficult to treat. We have shown previously that spinal application of dipeptidyl peptidase 4 (DPP4) inhibitors induces strong antihyperalgesic effect during inflammatory pain. In this study we observed low level of DPP4 mRNA in the rat spinal dorsal horn in physiological conditions, which did not change significantly either in carrageenan-induced inflammatory or partial nerve ligation-generated neuropathic states. In naïve animals, microglia and astrocytes expressed DPP4 protein with one and two orders of magnitude higher than neurons, respectively. DPP4 significantly increased in astrocytes during inflammation and in microglia in neuropathy. Intrathecal application of two DPP4 inhibitors tripeptide isoleucin-prolin-isoleucin (IPI) and the antidiabetic drug vildagliptin resulted in robust opioid-dependent antihyperalgesic effect during inflammation, and milder but significant opioid-independent antihyperalgesic action in the neuropathic model. The opioid-mediated antihyperalgesic effect of IPI was exclusively related to mu-opioid receptors, while vildagliptin affected mainly delta-receptor activity, although mu- and kappa-receptors were also involved. None of the inhibitors influenced allodynia. Our results suggest pathology and glia-type specific changes of DPP4 activity in the spinal cord, which contribute to the development and maintenance of hyperalgesia and interact with endogenous opioid systems.

Application of Zhen-Jiu therapy in treating diabetic neuropatic pain

Application of Zhen-Jiu therapy in treating diabetic neuropatic pain

Duloxetine-induced ejaculation with defacation: a case report

Duloxetine, a serotonin and norepinephrine reuptake inhibitor, is succesfully used for major depressive disorder, generalized anxiety disorder, stress incontinence, diabetic neuropatic pain and fibromyalgia treatment. Most common side effects of duloxetine are nausea, dry mouth, constipation, sleep disorder, dizziness, fatigue, somnolence, tremor. In short time studies of duloxetine suggest that sexual dysfunction occur with duloxetine less than SSRI. Although sexual side effects such as low ibido, orgasm disorder, ejaculation disorder are common side effects of antidepressant drugs, sponton ejaculation is a side effects that occurs rarely. On the other hand both psychiatric disorders and drugs which used psychiatric disorders affect defecation frequency and form in addition it can cause that patients can have some problems in own daily life. In this paper, case of duloxetine-induced ejaculation with defacation is discussed.

Treatment of severe neuropatic pain for patients with the syndrome of Klippel-Trenaunay-Weber: case report

Introduction: Klippel-Trenaunay-Weber syndrome is a rare congenital anomaly whose etiology has not yet been elucidated. It is characterized by the triad of vascular malformations, cutaneous hemangiomas and overgrowth of bone and soft tissue adjacent. Pain is a common symptom and can be triggered in the following situations: venous disease, scoliosis by the different members and hemangiomas that affect the body surface, the deep planes or viscera. Case report: A female patient, 17, sent from the SARAH Hospital - Fortaleza to the Institute of Clinic Pain José Frota diagnosed with cerebral palsy type triplegia on right eye and anophthalmia featuring an expansive process of vascular origin extending to the paraspinal region, surpassing sciatic foramen and affecting posterior muscles of the left thigh and leg. There are signs of involvement of the sciatic nerve and deep femoral vessels. He was diagnosed with Klippel-Trenaunay-Weber syndrome. She had continuous pain in shock and burning, EVA 10, extending from the lower back, groin and left leg region. The source of hospital treatment consisted of gabapentin 180mg 12/12h, codeine 10mg 12/12h, ibuprofen 300mg 12/12h, codeine/paracetamol 30mg 12/12h and morphine oral 10mg while in pain, but without pain relief. She also used paroxetine 20mg daily, due to depression. The painful condition prevented sleep, caused irritation and worsened the quality of life of the patient. She continued treatment with gabapentin 300mg 12/12h, dipyrone 500mg 12/12h, Methadone 5mg 12/12h and reassessed two weeks showing significant improvement in pain symptoms and sleep, EVA 2. Conclusion: Pain is a symptom commonly described in the clinical picture of patients with this syndrome. The treatment of this disease is still a challenge. The malformations great gifts made it not always possible embolization or painkillers locks. The therapeutic results with strong opioid were satisfactory and have improved the quality of life of the patient.

The Role of TRPA1 and TRPV1 Channels in Orofacial Pain

Inflammation of the trigeminal nerve is considered one of the most painful conditions known to humankind. The diagnosis is often difficult moreover, safe and effective pharmacological treatments are lacking.Transient receptor potential (TRP) channels are a large family of non-selective cation channels. Several TRP channel family members, including TRP cation channel subfamily V member 1 (TRPV1), subfamily A member 1 (TRPA1) and TRP channel melastatin 8 (TRPM8), are expressed in TG somatosensory neurons, which also project within the oral and nasal cavities and are deputed to detect a great deal of external stimuli, including pressure, temperature, and chemicals.In recent years many efforts have been dedicated to the discovery of better and safer analgesics. However the medical need for this type of drugs remains substantially unmet. In particular, compounds capable of targeting both inflammatory and neuropathic pain are lacking.Thus, capitalizing on recent results [1] about the ability of the synthetic TRPA1 antagonist ADM_09 to revert oxaliplatin-induced neuropatic pain, and given the evident role of TRP channels in TG-related pain, we report herein on the synthesis of a new lipoic-containing antagonist namely ADM_12. This water-soluble small molecule, structurally simpler and more stable than ADM_09, showed: i) a remarkable safe profile; ii) a high binding constant vs. TRPA1; iii) an intriguing behaviour vs. TRPV1 and iv) the ability to significantly and persistently reduce mechanical facial allodynia in rats. Noteworthy, testing ADM_12 we shed light on the unprecedented involvement of both TRPA1 and TRPV1 channels in orofacial pain.[1] C. Nativi, R. Gualdani et al. (2013) Sci. Rep. 3, 2005, 1-10.

Intrathecal administration of mesenchymal stem cells reduces the reactive oxygen species and pain behavior in neuropathic rats.

BackgroundNeuropathic pain induced by spinal or peripheral nerve injury is very resistant to common pain killers, nerve block, and other pain management approaches. Recently, several studies using stem cells suggested a new way to control the neuropatic pain. In this study, we used the spinal nerve L5 ligation (SNL) model to investigate whether intrathecal rat mesenchymal stem cells (rMSCs) were able to decrease pain behavior, as well as the relationship between rMSCs and reactive oxygen species (ROS).MethodsNeuropathic pain of the left hind paw was induced by unilateral SNL in Sprague-Dawley rats (n = 10 in each group). Mechanical sensitivity was assessed using Von Frey filaments at 3, 7, 10, 12, 14, 17, and 24 days post-ligation. rMSCs (10 µl, 1 × 105) or phosphate buffer saline (PBS, 10 µl) was injected intrathecally at 7 days post-ligation. Dihydroethidium (DHE), an oxidative fluorescent dye, was used to detect ROS at 24 days post-ligation.ResultsTight ligation of the L5 spinal nerve induced allodynia in the left hind paw after 3 days post-ligation. ROS expression was increased significantly (P < 0.05) in spinal dorsal horn of L5. Intrathecal rMSCs significantly (P < 0.01) alleviated the allodynia at 10 days after intrathecal injection (17 days post-ligation). Intrathecal rMSCs administration significantly (P < 0.05) reduced ROS expression in the spinal dorsal horn.ConclusionsThese results suggest that rMSCs may modulate neuropathic pain generation through ROS expression after spinal nerve ligation.

Exploring the Architecture of the Outer Pore of the TRPV1 Channel with Double-Knot Toxin

The TRPV1 channel is a non-selective homotetrameric cation channel that acts in nociceptors as a sensor for external noxious chemicals and physical stimuli. It is also modulated by many cell-signaling molecules whose concentrations increase during inflammation and tissue damage. As a consequence, its function has been associated with inflammatory hyperalgesia and neuropatic pain. At present, little structural or mechanistic information is available for this protein. However, the pore domain is thought to play a fundamental role in channel function, since modulating signals are expected to converge on the pore to gate ion permeation. There is also growing evidence to suggest that the pore is the site of action of protons, possibly temperature, and the double ICK knot tarantula toxin (DkTx). DkTx, or its isolated single knots, have been proposed to bind to the external pore to promote activation. Here, we set out to study DkTx-TRPV1 interactions to gain structural information on the pore domain. By using a concatenated TRPV1 channel tetramer, in which toxin-activation was disrupted in specific subunits, we found that the binding of a single toxin knot is sufficient to promote channel activation. We also found that DkTx activates channels in which toxin-activation has been disrupted in either adjacent or opposite subunits, indicating that the knots of DkTx can arrange differently to activate the TRPV1 channel. Finally, we found that a hexa-histidine tag attached to the N-terminus of the toxin acts a voltage- and pH-dependent blocker. We are currently using variants of DkTx, in combination with concatenated TRPV1 channels, to delineate the toxin binding site on the external surface of the channel relative to the central pore and to probe agonist-dependent conformational changes in the pore.