pain

摘要： Traumatic painful neuroma is an intractable clinical disease characterized by improper extracellular matrix(ECM)deposition around the injury site.Studies have shown that the microstructure of natural nerves provides a suitable microenvironment for the nerve end to avoid abnormal hyperplasia and neuroma formation.In this study,we used a decellularized nerve matrix scaffold(DNM-S)to prevent against the formation of painful neuroma after sciatic nerve transection in rats.Our results showed that the DNM-S effectively reduced abnormal deposition of ECM,guided the regeneration and orderly arrangement of axon,and decreased the density of regenerated axons.The epineurium-perilemma barrier prevented the invasion of vascular muscular scar tissue,greatly reduced the invasion ofα-smooth muscle actin-positive myofibroblasts into nerve stumps,effectively inhibited scar formation,which guided nerve stumps to gradually transform into a benign tissue and reduced pain and autotomy behaviors in animals.These findings suggest that DNM-S-optimized neuroma microenvironment by ECM remodeling may be a promising strategy to prevent painful traumatic neuromas.

摘要： Peripheral nerve injury(PNI)causes sensory and motor deficits as well as neuropathic pain,which seriously impacts patient quality of life(Jiang et al.,2017).Morphological and molecular changes in the spinal cord and dorsal root ganglia(DRG),such as neuronal cell death,nerve fiber degeneration,and glial activation,are strongly associated with PNI-induced pathological syndromes.

摘要： Epidural electrical stimulation is a new treatment method for spinal cord injury(SCI).Its efficacy and safety have previously been reported.Rehabilitation treatment after epidural electrical stimulation is important to ensure and improve the postoperative efficacy of epidural electrical stimulation in patients with SCI.Considering that electromyography(EMG)-induced rehabilitation treatment can accurately match the muscle contraction of patients with SCI,we designed a study protocol for a prospective,randomized controlled trial.In this trial,on the premise of adjusting the spinal cord electrical stimulator to obtain the maximum EMG signal of the target muscle,patients with SCI receiving epidural electrical stimulation will undergo EMG-induced rehabilitation treatment.Recovery of muscle strength of key muscles,quality of life,safety and therapeutic effects will be monitored.Twenty patients with SCI who are scheduled to undergo epidural electrical stimulation in Shanghai Ruijin Rehabilitation Hospital will be randomly divided into two groups with 10 patients per group.The control group will receive conventional rehabilitation treatment.The EMG-induced rehabilitation group will receive EMG-induced rehabilitation treatment of the target muscles of the upper and lower limbs based on conventional rehabilitation treatment.After rehabilitation treatment,follow up for all patients will occur at 2 weeks and 1,3 and 6 months.The primary outcome measure of this trial will be evaluation of target muscle recovery using the Manual Muscle Testing grading scale.Secondary outcome measures will include modified Barthel Index scores,integrated EMG values,the visual analogue scale,Spinal Cord Independence Measure scores,and modified Ashworth scale scores.The safety indicator will be the incidence of adverse events.This trial will collect data regarding the therapeutic effects of EMG-induced rehabilitation in patients with SCI receiving epidural electrical stimulation for 6 months after rehabilitation treatment.Findings from this trial will help develop rehabilitation methods in patients with SCI after epidural electrical stimulation.This study protocol was approved by Ethics Committee of Shanghai Ruijin Rehabilitation Hospital(Approval No.RKIRB2022-12)on February 15,2022 and was registered with Chinese Clinical Trial Registry(registration number:ChiCTR2200061674;date:June 30,2022).Study protocol version:1.0.

摘要： BACKGROUND Fibromyalgia(FM)patients are treated with antidepressants,and in most cases,these drugs lose efficacy or present side effects.Intravenous lidocaine(IL)is an anesthetic drug used in some FM trials.AIM To systematically review the safety and efficacy of IL in FM patients.METHODS To systematically search PubMed for articles in English,Spanish,and Japanese with English Abstracts on FM and lidocaine between 1966 and February 2021.This study was registered at PROSPERO.RESULTS We found only ten articles published in this field,with a total of 461 patients.Females predominated varying from 95%to 100%in the studies.Age varied from 40.9 to 55 years old.Disease duration varied from 1 mo to 6.4 years.Lidocaine dose varied from 2 to 7.5 mg/kg via intravenous infusion.Follow-up period varied from 65.7 to 90 days.Regarding outcomes,most studies used the visual analogue scale(VAS)for pain;before short-term lidocaine administration,VAS was between 6.1 and 8.1 and after treatment was between 1.7 and 4.5 mm.Concerning long term lidocaine,VAS varied from 30%to 35.4%after lidocaine infusion.Side effects were observed in 0%to 39.6%of cases,they were usually mild or moderate.CONCLUSION This study demonstrates the short-term effectiveness and safety of intravenous lidocaine in FM patients.However,more studies,including long-term follow-up,are still needed.

摘要： Chronic pain is sustained by a phenomenon of hyper-activation of nociceptive neurons both at peripheral(peripheral sensitization)and central(central sensitization)levels.The onset and maintenance of pain,however,is to be found in the interaction among the various cell populations in the nervous tissue including neurons and glia(Nam et al.,2016).The pathogenesis of neuropathic pain is extremely complex depending on the primary cause of nerve damage,e.g.traumatic nerve injury is associated with a robust inflammatory response while chemotherapy-induced pain is characterized by a modest phlogistic component(Di Cesare Mannelli et al.,2013).Despite these differences,a powerful common concept to explain the cellular mechanisms underlying pain is the activation of glia.

摘要： Pain is one of the most common and distressing symptoms experienced by cancer patients and can cause significant physical and psychological complications for patients and their families. Adequate pain management requires an understanding of pain, its assessment, and the use of analgesics according to the WHO analgesic ladder;information that is often lacking in routine medical education. Understanding the level of knowledge, attitudes and practices of clinicians who treat cancer pain can help us prepare relevant educational programs to address this need. A cross-sectional descriptive study was conducted among randomly selected eligible clinical staff using self-administered questionnaires that contained close-ended and open-ended questions testing factual knowledge on pain, attitudes towards pain management, and practices related to pain management and opioid use. Results were analyzed using SPSS Version 28. Of 66 participants of this study, 78% were female and 65% were nurses. Only 10% had received any additional training in pain management. Knowledge on pain was found to be adequate in some areas, but deficient in others such as “types of pain” and “adjuvant drugs” (35% and 26% respectively). A significant proportion of responses (73%) showed incorrect attitudes towards pain and opioid use. Recommended practices such as prescribing laxatives with opioids were prevalent (72%), however using a tool to assess pain or the WHO ladder to prescribe analgesics was not as common. The results of this study show that despite being a key component of clinical care, pain management is not adequately understood by many clinicians. Gaps in knowledge, and incorrect attitudes could contribute to inadequate pain management for patients. This study provides valuable information for an educational workshop planned on pain management.

摘要： Aims: This service evaluation explored and reported findings from a new multi-disciplinary service where physiotherapists were incorporated into an orofacial team who managed patients with chronic Temporomandibular Dysfunction (TMD). Methods: We collected data before the physiotherapists’ involvement and on discharge from physiotherapy management. Outcomes were patient-reported pain (numerical rating scale (NRS 0 to 10)), patient specific functional score (PSFS), health-related quality of life (EQ-5D) and range of mandibular depression (mm). Exploratory analyses compared baseline to follow-up scores on discharge from physiotherapy. Results: 79 patients (mean age 40 (SD 18);female 87%) received physiotherapy. At discharge, there was a mean reduction in pain: 2.8 (95% CI 2.0 to 3.6), improvement in function: ﹣4.0 (95% CI ﹣4.7 to ﹣3.3), improvement in health: ﹣0.139 (95% CI ﹣0.196 to ﹣0.082) and increase in mandible depression: ﹣6.6. (95% CI ﹣9.1 to ﹣4.1). Conclusions: The results provide early, exploratory evidence that patients with chronic temporomandibular dysfunction treated by physiotherapists achieve clinically important changes in pain, function and health in the short term.

摘要： Objective:Knee osteoarthritis(KOA)is a common chronic joint disease that usually occurs in older people,and injuries articular cartilage and cartilage proliferation. Studies have shown that platelet-rich plasma(PRP),as one of non-surgical treatments,is used to alleviate the symptoms of patients with KOA,becoming popular with doctors. In this study,the purpose was to investigate the effects of platelet-rich plasma on the level of pain and function in patients with KOA. Methods:The Pubmed,Cochrane Library,Embase,and Medline were investigated from 2005 through May 2020. All randomized double-blind controlled trials on the effect of PRP injections for KOA were included. Outcome indicators included the Western Ontario and McMaster Universities Arthritis Index(WOMAC)and the Knee Osteoarthritis Outcome Score(KOOS)for function,the visual analogue scale(VAS)for pain,and adverse events(AEs). Review Manager 5.3 was used to calculate these outcome indicators. Results:In this study,(1)Seven studies met the eligibility criteria,including 250 patients in the experiment(PRP)group and 230 patients in the control(no PRP)group.(2)Meta-analysis results showed that the WOMAC scores were differed significantly between the PRP and no PRP groups at the 6 months follow-up(MD=9.63,95%CI:3.29 to 15.96,P=0.003),and 12 months follow-up(MD=3.85,95%CI:2.66 to 5.04,P0.05).(3)Results showed that PRP has significant advantages in pain relief and functional improvement. Conclusion:In improving knee function and relieving pain,PRP showed superiority to other non-surgical treatments in long-term follow-up from well-designed double-blind trials. Due to the limited quality and data,more high-quality multi-center studies are required.

摘要： BACKGROUND Several breast cancer studies have reported the use of adjuvant opioids with the paravertebral block(PVB)to improve outcomes.However,there is no level-1 evidence justifying its use.AIM To elucidate if the addition of opioids to PVB improves pain control in breast cancer surgery patients.METHODS We conducted an electronic literature search across PubMed,Embase,Scopus,and Google Scholar databases up to October 20,2020.Only randomized controlled trials(RCTs)comparing the addition of opioids to PVB with placebo for breast cancer surgery patients were included.RESULTS Six RCTs were included.Our meta-analysis indicated significantly reduced 24-h total analgesic consumption with the addition of opioids to PVB as compared to placebo[standardized mean difference(SMD)-1.57,95%confidence interval(CI):-2.93,-0.21,I2=94%].However,on subgroup analysis,the results were nonsignificant for studies using single PVB(SMD:-1.76,95%CI:-3.65,0.13 I2=95.09%)and studies using PVB infusion(SMD:-1.30,95%CI:-4.26,1.65,I2=95.49%).Analysis of single PVB studies indicated no significant difference in the time to first analgesic request between opioid and placebo groups(mean difference-11.28,95%CI:-42.00,19.43,I2=99.39%).Pain scores at 24 h were marginally lower in the opioid group(mean difference-1.10,95%CI:-2.20,0.00,I2=0%).There was no difference in the incidence of postoperative nausea and vomiting between the two groups.CONCLUSION Current evidence suggests a limited role of adjuvant opioids with PVB for breast cancer surgery patients.Further homogenous RCTs with a large sample size are needed to clarify the beneficial role of opioids with PVB.

摘要： Objective:To evaluate the antinociceptive activity of perillyl acetate in mice and in silico simulations.Methods:The vehicle,perillyl acetate(100,150 and/or 200 mg/kg,i.p.),diazepam(2 mg/kg,i.p.)or morphine(6 mg/kg,i.p.)was administered to mice,respectively.Rotarod test,acetic acidinduced abdominal writhing,formalin-induced nociception,hot plate test,and tail-flick test were performed.Opioid receptorsinvolvement in perillyl acetate antinociceptive effect was also investigated.Results:Perillyl acetate did not affect the motor coordination of mice.However,it reduced the number of acetic acid-induced abdominal twitches and licking times in the formalin test.There was an increase of latency time in the tail-flick test of 30 and 60minutes.Pretreatment with naloxone reversed the antinociceptive effect of perillyl acetate(200 mg/kg).In silico analysis demonstrated that perillyl acetate could bind toμ-opioid receptors.Conclusions:Perillyl acetate has antinociceptive effect at the spinal level in animal nociception models,without affecting the locomotor integrity and possibly throughμ-opioid receptors.In silico studies have suggested that perillyl acetate can act as aμ-opioid receptor agonist.