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chronic persistent nerve pain

Brian M Ilfeld
A continuous peripheral nerve block (CPNB) consists of a percutaneously inserted catheter with its tip adjacent to a target nerve/plexus through which local anesthetic may be administered, providing a prolonged block that may be titrated to the desired effect. In the decades after its first report in 1946, a plethora of data relating to CPNB was published, much of which was examined in a 2011 Anesthesia & Analgesia article. The current update is an evidence-based review of the CPNB literature published in the interim...
October 3, 2016: Anesthesia and Analgesia
W Ma, B St-Jacques, U Rudakou, Y N Kim
BACKGROUND: Persistent peripheral sensitization contributes to chronic pain. Plasticity of nociceptive dorsal root ganglion (DRG) neurons (nociceptors) induced by pro-inflammatory mediators contributes to sensitization. Prostaglandin E2 (PGE2) enriched in injured tissues is known not only directly to sensitize DRG neurons, but also to potentiate sensitizing effects of other pain mediators such as capsaicin and its receptor transient receptor potential vanilloid-1 (TRPV1). It remains unknown whether PGE2 potentiates TRPV1 activity by stimulating its synthesis, cell surface and axonal trafficking in DRG neurons...
October 14, 2016: European Journal of Pain: EJP
Perry Rosenthal, David Borsook, Eric A Moulton
The cornea is supplied principally by the ophthalmic branch of the trigeminal nerve and is the most densely innervated organ in the human body. Under normal conditions, the corneal nerve terminals incorporate sensors that monitor the thickness and integrity of the tear film, which are essential for meaningful vision. A disrupted tear film or direct noxious stimulation of these corneal nerves can produce discomfort or pain limited to the affected surface. Damage to these nerves can sometimes lead to a chronic neuropathic condition, where pain persists months following the initial insult, long after the nerves appear to have healed in the cornea itself following treatment...
October 1, 2016: Investigative Ophthalmology & Visual Science
Timothy J Ness, Alan Randich, Dwight E Nelson, Xin Su
BACKGROUND AND OBJECTIVES: Neuromodulation has been reported to reliably improve symptoms of bladder overactivity and sometimes pain. The effect of electrical stimulation of several nerve pathways demonstrated to alter cystometric responses to bladder distension was examined on nociceptive responses in models of bladder hypersensitivity. METHODS: Bladder hypersensitivity was produced by several published methods including neonatal inflammation, acute inflammation, and chronic stress...
September 28, 2016: Regional Anesthesia and Pain Medicine
Wenjuan Tao, Wenjie Zhou, Yuping Wang, Tingting Sun, Haitao Wang, Zhi Zhang, Yan Jin
The efficacy of opioids in patients with chronic neuropathic pain remains controversial. Although activation of δ-opioid receptors (DORs) in the brainstem reduces inflammation-induced persistent hyperalgesia, it is not effective under persistent neuropathic pain conditions and these clinical problems remain largely unknown. In this study, by using a chronic constriction injury (CCI) of the sciatic nerve in rats, we found that in the brainstem nucleus raphe magnus (NRM), DORs emerged on the surface membrane of central synaptic terminals on day 3 after CCI surgery and disappeared on day 14...
September 17, 2016: Neuroscience
Giuliano Taccola, Pierre J Doyen, Jonathan Damblon, Nejada Dingu, Beatrice Ballarin, Arnaud Steyaert, Anne des Rieux, Patrice Forget, Emmanuel Hermans, Barbara Bosier, Ronald Deumens
Tactile hypersensitivity is one of the most debilitating symptoms of neuropathic pain syndromes. Clinical studies have suggested that its presence at early postoperative stages may predict chronic (neuropathic) pain after surgery. Currently available animal models are typically associated with consistent tactile hypersensitivity and are therefore limited to distinguish between mechanisms that underlie tactile hypersensitivity as opposed to mechanisms that protect against it. In this study we have modified the rat model of spared nerve injury, restricting the surgical lesion to a single peripheral branch of the sciatic nerve...
September 15, 2016: Experimental Neurology
Lien Wang, Yan Zhang, Zhiwei Wang, Nian Gong, Tae Dong Kweon, Benjamin Vo, Chaoran Wang, Xiuli Zhang, Jae Yoon Chung, Amal Alachkar, Xinmiao Liang, David Z Luo, Olivier Civelli
Corydalis yanhusuo. W.T. extracts (YHS) are widely used for the treatment of pain and inflammation. There are a few studies that assessed the effects of YHS in pain assays; however, none of these studies has systematically compared its activities in the different pain animal modes namely: acute, inflammatory and chronic pain. Furthermore, little is known about the mechanism of YHS activity in these assays. The aim of this study was to systematically evaluate the antinociceptive properties of YHS by testing it in four standardized pain assays and to investigate its mechanism...
2016: PloS One
Christoforos Tsantoulas, Elizabeth R Mooney, Peter A McNaughton
Nociception - the ability to detect painful stimuli - is an invaluable sense that warns against present or imminent damage. In patients with chronic pain, however, this warning signal persists in the absence of any genuine threat and affects all aspects of everyday life. Neuropathic pain, a form of chronic pain caused by damage to sensory nerves themselves, is dishearteningly refractory to drugs that may work in other types of pain and is a major unmet medical need begging for novel analgesics. Hyperpolarisation-activated cyclic nucleotide (HCN)-modulated ion channels are best known for their fundamental pacemaker role in the heart; here, we review data demonstrating that the HCN2 isoform acts in an analogous way as a 'pacemaker for pain', in that its activity in nociceptive neurons is critical for the maintenance of electrical activity and for the sensation of chronic pain in pathological pain states...
September 15, 2016: Biochemical Journal
Ted B Usdin, Eugene L Dimitrov
Chronic pain is frequently associated with anxiety, depression, and cognitive dysfunction. This review discusses recent work in rodents that contributes to the understanding of their neurobiological links. Brain regions that contain circuits that mediate persistent changes in behavior that are caused by nerve injury or joint inflammation include the rostral anterior cingulate and other parts of the medial prefrontal cortex, the basolateral and central nucleus of the amygdala, and the nucleus accumbens. Functional changes, including increases in the activity within specific neuronal pathways and in the levels of specific synaptic components, that are associated with the behavior changes, or are in some cases necessary for them, have recently been identified...
October 2016: Neuroscientist: a Review Journal Bringing Neurobiology, Neurology and Psychiatry
Stephan Becker, Alexander Hadjipavlou, Michael H Heggeness
BACKGROUND CONTENT: Lumbar axial back pain arising from degenerative disc disease continues to be a challenging clinical problem whether treated with non-surgical management, local injection, or motion segment stabilization and fusion. PURPOSE: To determine the efficacy of intraosseous basivertebral nerve ablation for the treatment of chronic lumbar back pain in a clinical setting. STUDY DESIGN: Patients meeting predefined inclusion/exclusion criteria were enrolled in a study using RF energy to ablate the basivertebral nerve within the vertebral bodies adjacent to the diagnosed level...
September 1, 2016: Spine Journal: Official Journal of the North American Spine Society
Durval Campos Kraychete, Rioko Kimiko Sakata, Leticia de Oliveira Carvalho Lannes, Igor Dórea Bandeira, Eduardo Jun Sadatsune
BACKGROUND AND OBJECTIVES: Postoperative persistent chronic pain (POCP) is a serious health problem, disabling, undermining the quality of life of affected patients. Although more studies and research have addressed the possible mechanisms of the evolution from acute pain to chronic postoperatively, there are still no consistent data about the risk factors and prevention. This article aims to bring what is in the panorama of the current literature available. CONTENT: This review describes the definition, risk factors, and mechanisms of POCD, its prevention and treatment...
September 2016: Brazilian Journal of Anesthesiology
Bálint Botz, Kata Bölcskei, Zsuzsanna Helyes
Chronic inflammatory diseases and persistent pain of different origin represent common medical, social, and economic burden, and their pharmacotherapy is still an unresolved issue. Therefore, there is a great and urgent need to develop anti-inflammatory and analgesic agents with novel mechanisms of action, but it is a very challenging task. The main problem is the relatively large translational gap between the preclinical experimental data and the clinical results due to characteristics of the models, difficulties with the investigational techniques particularly for pain, as well as species differences in the mechanisms...
August 31, 2016: Wiley Interdisciplinary Reviews. Nanomedicine and Nanobiotechnology
Gang Chen, Rou-Gang Xie, Yong-Jing Gao, Zhen-Zhong Xu, Lin-Xia Zhao, Sangsu Bang, Temugin Berta, Chul-Kyu Park, Mark Lay, Wei Chen, Ru-Rong Ji
Mechanisms of acute pain transition to chronic pain are not fully understood. Here we demonstrate an active role of β-arrestin 2 (Arrb2) in regulating spinal cord NMDA receptor (NMDAR) function and the duration of pain. Intrathecal injection of the mu-opioid receptor agonist [D-Ala(2), NMe-Phe(4), Gly-ol(5)]-enkephalin produces paradoxical behavioural responses: early-phase analgesia and late-phase mechanical allodynia which requires NMDAR; both phases are prolonged in Arrb2 knockout (KO) mice. Spinal administration of NMDA induces GluN2B-dependent mechanical allodynia, which is prolonged in Arrb2-KO mice and conditional KO mice lacking Arrb2 in presynaptic terminals expressing Nav1...
August 19, 2016: Nature Communications
Pascale Vergne-Salle
Chronic postsurgical pain (CPSP) affects 10 to 30% of surgical patients overall and 16 to 20% of patients after knee surgery. Patients report persistent pain in the absence of infection, mechanical disorders, or complex regional pain syndrome type I. In many cases, the mechanism is neuropathic pain related to an intraoperative nerve injury or impaired pain modulation with central sensitization. The clinical risk factors and pathophysiology of CPSP are being actively investigated. Risk factors include preoperative pain; diffuse pain; severe pain during the immediate postoperative period; anxiety, depression, or cognitive distortions such as catastrophizing; and comorbidities...
July 14, 2016: Joint, Bone, Spine: Revue du Rhumatisme
Walter Kostich, Brian D Hamman, Yu-Wen Li, Sreenivasulu Naidu, Kumaran Dandapani, Jianlin Feng, Amy Easton, Clotilde Bourin, Kevin Baker, Jason Allen, Katerina Savelieva, Justin V Louis, Manoj Dokania, Saravanan Elavazhagan, Pradeep Vattikundala, Vivek Sharma, Manish Lal Das, Ganesh Shankar, Anoop Kumar, Vinay K Holenarsipur, Michael Gulianello, Ted Molski, Jeffrey M Brown, Martin Lewis, Yanling Huang, Yifeng Lu, Rick Pieschl, Kevin O'Malley, Jonathan Lippy, Amr Nouraldeen, Thomas H Lanthorn, Guilan Ye, Alan Wilson, Anand Balakrishnan, Rex Denton, James E Grace, Kimberley A Lentz, Kenneth S Santone, Yingzhi Bi, Alan Main, Jon Swaffield, Ken Carson, Sandhya Mandlekar, Reeba K Vikramadithyan, Susheel J Nara, Carolyn Dzierba, Joanne Bronson, John E Macor, Robert Zaczek, Ryan Westphal, Laszlo Kiss, Linda Bristow, Charles M Conway, Brian Zambrowicz, Charles F Albright
To identify novel targets for neuropathic pain, 3097 mouse knockout lines were tested in acute and persistent pain behavior assays. One of the lines from this screen, which contained a null allele of the adapter protein-2 associated kinase 1 (AAK1) gene, had a normal response in acute pain assays (hot plate, phase I formalin), but a markedly reduced response to persistent pain in phase II formalin. AAK1 knockout mice also failed to develop tactile allodynia following the Chung procedure of spinal nerve ligation (SNL)...
September 2016: Journal of Pharmacology and Experimental Therapeutics
Qian Zhang, De-Li Cao, Zhi-Jun Zhang, Bao-Chun Jiang, Yong-Jing Gao
BACKGROUND: Trigeminal nerve damage-induced neuropathic pain is a severely debilitating chronic orofacial pain syndrome. Spinal chemokine CXCL13 and its receptor CXCR5 were recently demonstrated to play a pivotal role in the pathogenesis of spinal nerve ligation-induced neuropathic pain. Whether and how CXCL13/CXCR5 in the trigeminal ganglion (TG) mediates orofacial pain are unknown. METHODS: The partial infraorbital nerve ligation (pIONL) was used to induce trigeminal neuropathic pain in mice...
2016: Journal of Neuroinflammation
Jason McCarthy, Amy Davis
Vertebral compression fractures (VCFs) are the most common complication of osteoporosis, affecting more than 700,000 Americans annually. Fracture risk increases with age, with four in 10 white women older than 50 years experiencing a hip, spine, or vertebral fracture in their lifetime. VCFs can lead to chronic pain, disfigurement, height loss, impaired activities of daily living, increased risk of pressure sores, pneumonia, and psychological distress. Patients with an acute VCF may report abrupt onset of back pain with position changes, coughing, sneezing, or lifting...
July 1, 2016: American Family Physician
Bruce Mitchell, Paul Verrills, David Vivian, Neels DuToit, Adele Barnard, Chantelle Sinclair
OBJECTIVE: Relative to the number of patients suffering chronic lumbar and cervical pain, fewer patients suffer persistent thoracic pain. Consequently there is less literature, with smaller sample sizes, reporting treatment of this cohort. Here, we assess peripheral nerve field stimulation (PNfS) as a potential treatment for chronic thoracic pain. MATERIALS AND METHODS: This study included 20 consecutive chronic thoracic pain sufferers that responded successfully to PNfS trial...
July 4, 2016: Neuromodulation: Journal of the International Neuromodulation Society
Martin Jakobs, Andreas Unterberg, Rolf-Detlef Treede, Sigrid Schuh-Hofer, Rezvan Ahmadi
BACKGROUND: Neurosurgical pain management of drug-resistant trigeminal neuralgia (TN) is highly challenging. Microvascular decompression is a first-line neurosurgical approach for classical TN with neurovascular conflict, but can show clinical relapse despite proper decompression. Second-line destructive techniques like radiofrequency thermocoagulation have become reluctantly used due to their potential for irreversible side effects. Subcutaneous peripheral nerve field stimulation (sPNFS) is a minimally invasive neuromodulatory technique which has been shown to be effective for chronic localised pain conditions...
September 2016: Acta Neurochirurgica
Leonardo Kapural, Suneil Jolly
Treatment of persistent pain from chronic pancreatitis historically was difficult to treat. For years, focus was on opioid and other analgesics and psychological treatments. Recent studies provided evidence for decrease in analgesic intake and pain scores after properly conducted sympathetic blocks (celiac, splanchnic nerve blocks). These therapies should be considered as parts of a multimodal analgesic strategy. Animal studies suggest that spinal cord stimulation suppresses visceral hyperalgesia. Large case series of spinal cord stimulation demonstrated a significant pain relief in patients with chronic pancreatitis...
September 2016: Current Treatment Options in Gastroenterology
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