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Analgesics and analgesic adjuvants inhibiting nerve conduction in the frog sciatic nerve —local anesthetics, opioids, α2 adrenoceptor agonists, antiepileptics, antidepressants and NSAIDs 抑制蛙坐骨神经神经传导的镇痛药和镇痛助剂——局部麻醉剂、阿片类药物、α2肾上腺素受体激动剂、抗癫痫药、抗抑郁药和非甾体抗炎药
Pub Date : 2019-12-20 DOI: 10.11154/pain.34.291
E. Kumamoto, T. Fujita
Many of analgesics and analgesic adjuvants act on nerve conduction and synaptic transmission in the nervous system to inhibit nociceptive transmission. It has not been fully examined how nerve conduction inhibition leading to antinociception differs in extent among various analgesics and analgesic adjuvants. We examined quantitatively their actions on fast–conducting compound action potentials (CAPs) recorded from the frog sciatic nerve. Drugs tested were local anesthetics, opioids, adrenoceptor agonists, antiepileptics, antidepressants and non–steroidal anti– inflam matory drugs (NSAIDs). As a result, we found that many of their drugs reduce the peak amplitude of the CAPs in a manner dependent on their chemical structures. Consistent with voltage–gated Na + –channel inhibition produced by local anesthetics, CAP peak amplitudes were reduced by procaine, cocaine, tetracaine, prilocaine, lidocaine, ropivacaine, levobupivacaine and pramoxine with the half– maximal inhibitory concentration (IC 50 ) values of 2 . 2 , 0 . 80 , 0 . 013 , 1 . 8 , 0 . 74 , 0 . 34 , 0 . 23 and 0 . 21 mM, respectively. A weak opioid tramadol reduced CAP peak amplitude s (IC 50 = 2 . 3 mM) more effectively than its metabolite mono– O – demethyl–tramadol; this distinction was attributed to such a difference in chemical structure that tramadol and mono– O –demethyl–tramadol have –OCH 3 and –OH bound to a benzene ring, respectively. Moreover, NSAIDs [tolfenamic acid, meclofenamic acid and flufenamic acid (IC 50 values: 0 . 29 , 0 . 19 and 0 . 22 mM, respectively)]. On the other hand, salicylic acid–based (aspirin), propionic acid–based (ketoprofen, ibuprofen, naproxen, loxoprofen and flurbiprofen) and enolic acid–based (meloxicam and piroxicam) NSAIDs had no effect on CAPs. In conclusion, CAP inhibitions produced by local anesthetics were partly comparable in extent to those of a 2 –adrenoceptor agonists, antiepileptics, antidepressants and NSAIDs; opioids inhibited CAPs less potently than their drugs. It is suggested that analgesics and analgesic adjuvants inhibit nerve conduction in a manner dependent on their chemical structures.
许多镇痛药和镇痛佐剂作用于神经系统的神经传导和突触传递,抑制伤害性传递。神经传导抑制导致的抗痛觉作用在不同镇痛药和镇痛佐剂之间的程度如何不同还没有得到充分的研究。我们定量地检测了它们对青蛙坐骨神经记录的快速传导复合动作电位(CAPs)的作用。测试的药物包括局麻药、阿片类药物、肾上腺素受体激动剂、抗癫痫药、抗抑郁药和非甾体抗炎药(NSAIDs)。结果,我们发现他们的许多药物以一种依赖于其化学结构的方式降低了cap的峰值幅度。普鲁卡因、可卡因、丁卡因、普丙卡因、利多卡因、罗哌卡因、左旋布比卡因和普拉莫辛均可降低CAP峰幅,半数最大抑制浓度(IC 50)为2,与局麻药产生的电压门控Na +通道抑制一致。2,0。80,0。[13, 1]8,0。74,0。34,0。23和0。分别为21毫米。弱阿片类药物曲马多降低了CAP峰振幅s (ic50 = 2)。3 mM)比其代谢物单O -去甲基曲马多更有效;这种区别是由于曲马多和单- O -去甲基曲马多在化学结构上的差异,它们的苯环上分别有- och 3和- oh键。非甾体抗炎药[甲氯芬那酸、甲氯芬那酸和氟芬那酸]的ic50值为0。29,0。19和0。22 mM)]。另一方面,水杨酸类非甾体抗炎药(阿司匹林)、丙酸类非甾体抗炎药(酮洛芬、布洛芬、萘普生、洛洛芬和氟比洛芬)和烯酸类非甾体抗炎药(美洛昔康和吡洛昔康)对CAPs无影响。综上所述,局麻药对CAP的抑制作用在一定程度上与a - 2肾上腺素受体激动剂、抗癫痫药、抗抑郁药和非甾体抗炎药相当;阿片类药物对cap的抑制作用不如药物。这表明,镇痛药和镇痛佐剂抑制神经传导的方式依赖于它们的化学结构。
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引用次数: 0
Mechanism of weather–related pain 与天气有关的疼痛机制
Pub Date : 2019-12-20 DOI: 10.11154/pain.34.312
J. Sato
Chronic pain is known to get worse under the influence of weather change (tempera -ture, humidity, pressure). This is generally called “weather–related pain”. The author believes that the pressure sensor in the inner ear and the autonomic nervous system imbalance are involved in the mechanism of worsening pain and associated symptoms due to a decrease in atmospheric pressure. In addition, the activation mechanism of the cold receptor on skin occurs in chronic pain, which is considered to be the main role of the mechanism of aggravation of chronic pain under low tem perature environments.
众所周知,慢性疼痛在天气变化(温度、湿度、压力)的影响下会加重。这通常被称为“与天气有关的疼痛”。作者认为,内耳中的压力传感器和自主神经系统失衡与大气压力降低导致疼痛和相关症状恶化的机制有关。此外,皮肤上冷受体的激活机制发生在慢性疼痛中,这被认为是低温环境下慢性疼痛加重机制的主要作用。
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引用次数: 0
Cellular mechanisms for antinociception produced by hypothalamus–derived neuropeptides in the rat spinal superficial dorsal horn —oxytocin and orexins actions 大鼠脊髓浅背角下丘脑来源的神经肽产生镇痛感受的细胞机制——催产素和食欲素的作用
Pub Date : 2019-09-20 DOI: 10.11154/pain.34.228
E. Kumamoto, T. Fujita, Chong Wang
There is much evidence showing that a group of neuropeptides produced in the hypo thalamus, oxytocin and orexins, inhibit nociceptive transmission in the rat spinal dorsal horn. In order to reveal cellular mechanisms underlying this antinociception, we examined how oxytocin, orexins A and B affect spontaneous synaptic transmission in rat spinal lamina II (substantia gelatinosa; SG) neurons, which play a pivotal role in regulating nociceptive transmission. The experiments were performed by applying the blind whole–cell patch–clamp technique to SG neurons in adult rat spinal cord slices. Bath–applied oxytocin unaffected glutamatergic spontaneous excitatory transmission while producing an inward current at − 70 mV (membrane depolarization) and enhancing both GABAergic and glycinergic spontaneous inhibitory transmissions in > 70 % of the neurons tested. The depolarization, and increased GABAergic and glycinergic spontaneous inhibitory postsynaptic current (sIPSC) frequencies were concentration–dependent with half–maximal effective concentration (EC 50 ) values of 0 . 022 , 0 . 024 and 0 . 038 µM, respectively. On the other hand, orexins A and B produced an inward current at − 70 mV and/or increased the frequency of spontaneous excitatory postsynaptic current (sEPSC) without changing its amplitude in some 70 % of the neurons examined. EC 50 values for orexin A in their effects were 0 . 0045 and 0 . 030 µM, respectively; those for orexin B were 0 . 020 and 0 . 039 µM, respectively. EC 50 value for orexin B in producing inward current was similar to that of oxytocin nist (SB 334867 ) but not an orexin– 2 receptor antagonist (JNJ 10397049 ) while orexin B activities were inhibited by JNJ 10397049 but not SB 334867 , indicating that orexins A and B activities are mediated by orexin– 1 and – 2 receptors, respectively. It is concluded that oxytocin, orexins A and B increase neuronal activity through membrane depolari zation and/or increased L –glutamate release from nerve terminals, by activating their specific receptors, which in turn results in GABAergic and/or glycinergic spontaneous inhibitory transmission enhancements, a possible mechanism for antinociception.
有大量证据表明,下丘脑中产生的一组神经肽,催产素和食欲素,抑制了大鼠脊髓背角的伤害性传递。为了揭示这种抗伤害感受的细胞机制,我们研究了催产素、食欲素A和B如何影响大鼠脊髓II层(胶状质;SG)神经元的自发突触传递,后者在调节伤害感受传递中起着关键作用。实验采用盲全细胞膜片钳技术对成年大鼠脊髓切片中的SG神经元进行。Bath–应用催产素未受影响的谷氨酸能自发兴奋性传输,同时产生−70 mV的内向电流(膜去极化),并在>70%的受试神经元中增强GABA能和甘氨酸能自发抑制性传输。去极化以及GABA能和甘氨酸能自发抑制性突触后电流(sIPSC)频率的增加是浓度依赖性的,半最大有效浓度(EC 50)值为0。022,0。024和0。038µM。另一方面,食欲素A和B在约70%的受检神经元中产生−70 mV的内向电流和/或增加自发兴奋性突触后电流(sEPSC)的频率,而不改变其振幅。orexin A在其作用中的EC 50值为0。0045和0。030µM;食欲素B为0。020和0。039µM。食欲素B产生内向电流的EC 50值与催产素nist(SB 334867)相似,但不是食欲素-2受体拮抗剂(JNJ 10397049),而食欲素B的活性被JNJ 103970 49抑制,但不是SB 334866,这表明食欲素A和B的活性分别由食欲素-1和-2受体介导。结论是,催产素、食欲素A和B通过激活其特异性受体,通过膜去极化和/或增加神经末梢的L-谷氨酸释放,增加神经元活性,进而导致GABA能和/或甘氨酸能的自发抑制性传递增强,这是一种可能的抗伤害感受机制。
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引用次数: 1
Analgesic effect of TRPV4 blockade on bladder pain in chronic cystitis mice TRPV4阻断剂对慢性膀胱炎小鼠膀胱疼痛的镇痛作用
Pub Date : 2019-09-20 DOI: 10.11154/pain.34.240
Shiori Kawasaki, M. Fujita, Isamu Nanchi, Sunao Imai, Yasuhide Morioka, T. Asaki
Interstitial cystitis ⁄ painful bladder syndrome (IC ⁄ PBS) is a chronic bladder disorder accompanied by urinary dysfunction and bladder pain. The bladder pain is often resistant to current analgesics, such as amitriptyline and gabapentin, and decreases the quality of life for patients with IC ⁄ PBS. Novel analgesics with greater efficacy are urgently required; however, the pain mechanism in IC ⁄ PBS is not fully understood. Transient receptor potential vanilloid– 4 (TRPV 4 ) is expressed in the bladder epithelium to detect the mechanical stimulation associated with cell swelling and shear stress. Some reports have shown the involvement of TRPV 4 in urinary dysfunction in rodent models, but little is known about bladder pain. Therefore, we investigated whether TRPV 4 could be involved in the bladder pain induced by cyclophosphamide (CYP) in mice. Repeated intraperitoneal injection of CYP at 150 mg/kg for 4 days produced mild edema with some infiltration of inflammatory cells in the bladder, and persist ent mechanical hypersensitivity in the lower abdomen of mice. The phosphorylated TRPV 4 was significantly increased in the bladder of chronic cystitis mice, although the level of TRPV 4 mRNA and the distribution of TRPV 4 were not changed in the bladder compared with vehicle–injected mice. The gene depletion of TRPV 4 com-pletely prevented mechanical hypersensitivity in chronic cystitis mice. In addition, oral administration of the TRPV 4 antagonist, GSK 2193874 , inhibited mecha nical hyper sensitivity in these mice. These results show that the TRPV 4 antagonis t may become a therapeutic option for bladder pain in patients with IC ⁄ PBS.
间质性膀胱炎⁄疼痛性膀胱综合征(IC⁄PBS)是一种伴有尿功能障碍和膀胱疼痛的慢性膀胱疾病。膀胱疼痛通常对目前的止痛药(如阿米替林和加巴喷丁)具有耐药性,并降低IC⁄PBS患者的生活质量。迫切需要更有效的新型镇痛剂;然而,IC⁄PBS中的疼痛机制尚不完全清楚。瞬时受体电位香草素-4(TRPV 4)在膀胱上皮中表达,以检测与细胞肿胀和剪切应力相关的机械刺激。一些报道显示TRPV4参与啮齿类动物模型的尿功能障碍,但对膀胱疼痛知之甚少。因此,我们研究了TRPV 4是否与环磷酰胺(CYP)诱导的小鼠膀胱疼痛有关。连续4天重复腹膜内注射150 mg/kg的CYP会产生轻度水肿,膀胱中有一些炎症细胞浸润,并在小鼠下腹部持续存在机械性超敏反应。磷酸化的TRPV 4在慢性膀胱炎小鼠的膀胱中显著增加,尽管与载体注射小鼠相比,TRPV 4的mRNA水平和分布在膀胱中没有改变。TRPV 4基因的缺失完全阻止了慢性膀胱炎小鼠的机械超敏反应。此外,口服TRPV 4拮抗剂GSK 2193874可抑制这些小鼠的机械超敏反应。这些结果表明,TRPV 4拮抗剂可能成为IC⁄PBS患者膀胱疼痛的治疗选择。
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引用次数: 0
Evaluation of spontaneous oro–facial neuropathic pain in animal model using high resolution MRI 用高分辨率MRI评价动物模型自发性口面神经性疼痛
Pub Date : 2019-09-20 DOI: 10.11154/pain.34.254
A. Nakae, K. Nakai, H. Kato, J. Hatazawa, Y. Yoshioka, T. Yanagida
Introduction: In our clinical situation, pain is evaluated by the subjective complaints reported by patients because an objective measurement is still unrealizable. As an alter native, we usually evaluate pain–related behaviour to analyze animal pain. However, the phenomenon of analyzing pain–related behaviour is limited because some amounts of stimulations are required to be provided first. At present, the opinion that pain–related behaviour is not a response to pain but a mere reflex still cannot be completely disproved. Moreover, as observed with chronic pain patients, pain triggered by some kind of stimuli is less important than pain experienced continuous ly in a given period from our group’s clinical data. This means that the common pain study using the general way of evaluation cannot contribute to new analgesics’ discovery which patients are eager to await. The goal of this study is to evaluate rodents’ spontaneous pain objectively without any stimulation by high resolutio n MRI. Methods: All surgical and experimental protocols were approved by the Institutional Animal Care and Use Committee of Osaka university graduate school of medicine. 31 male Wister rats were anesthetized with sodium pentobarbital (60 mg/kg i.p.) and sevoflurane (2 – 3%). An infra–orbital nerve (ION) loose ligation model was made by the procedure that two nylon (5–0) ligatures (2 mm apart) were loosely tied around the ION. Sham–operation was performed only by cutting the skin on the face and suturing in the same way as the procedure of ION loose ligation model. The scanning schedule was set 3 weeks after surgery and 3 days before the scanning day, 5 mg/kg manganese was injected intraperitoneally for three days. MRI measurements were performed with an 11.7 T MR scanner (AVANCE 500WB, Bruker BioSpin MRI GmbH, Ettlingen, Germany), under isoflurane anesthesia (2 – 2.5%), T1 weighted MR–images were acquired with a spin echo sequence. All the images were standardized and divided into 52 areas automatically and uptakes of manganese were analyzed. Tukey–Kramer multiple comparison test and correlation analyses were performed using JMP12.0.0 software.
引言:在我们的临床情况下,疼痛是通过患者报告的主观抱怨来评估的,因为客观的测量仍然无法实现。作为另一个本地人,我们通常会评估与疼痛相关的行为来分析动物的疼痛。然而,分析疼痛相关行为的现象是有限的,因为需要首先提供一定量的刺激。目前,与疼痛相关的行为不是对疼痛的反应,而仅仅是一种反射的观点仍然不能完全推翻。此外,正如在慢性疼痛患者身上观察到的那样,根据我们小组的临床数据,某种刺激引发的疼痛不如在给定时期内持续经历的疼痛重要。这意味着,使用一般评估方法进行的普通疼痛研究无法有助于发现患者渴望等待的新止痛药。本研究的目的是通过高分辨率MRI客观评估啮齿类动物在没有任何刺激的情况下的自发疼痛。方法:所有手术和实验方案均经大阪大学医学研究生院动物护理和使用委员会批准。31只雄性Wister大鼠用戊巴比妥钠(60 mg/kg i.p.)和七氟醚(2-3%)麻醉。通过将两条尼龙(5–0)结扎线(间隔2 mm)松散地绑在眶下神经(ION)周围的程序,制作了眶下神经松散结扎模型。Sham–手术仅通过切割面部皮肤并按照与ION松动结扎模型相同的方式进行缝合。扫描时间表设定在手术后3周和扫描日前3天,腹膜内注射5mg/kg锰,持续3天。MRI测量采用11.7T MR扫描仪(AVANCE 500WB,Bruker BioSpin MRI GmbH,Ettlingen,Germany),在异氟烷麻醉(2-2.5%)下进行,T1加权MR图像采用自旋回波序列采集。所有的图像都被标准化并自动划分为52个区域,并分析锰的吸收。使用JMP12.0.0软件进行Tukey–Kramer多重比较测试和相关性分析。
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引用次数: 0
MicroRNA and long non–coding RNA in neuropathic pain 神经性疼痛中的MicroRNA和长链非编码RNA
Pub Date : 2019-09-20 DOI: 10.11154/pain.34.219
A. Sakai, Motoyo Maruyama, Hidenori Suzuki
Non–coding RNAs affect various cellular processes through interaction with DNA, RNA and protein. Accordingly, non–coding RNAs, microRNAs and more recently long non–coding RNAs, have been shown to be involved in pain disorders, including neuropathic pain. MicroRNAs inhibit translational step of gene expression and dysregulation of microRNAs underlies the neuropathic pain. On the other hand, lncRNAs regulate diverse steps of gene expression, including epigenetic modulation, transcription, alternative splicing and translation, although a role of lncRNAs in the pain disorders remain poorly understood. Interestingly, a part of non–coding RNAs are released to extracellular space and mediate a cell–cell communication. Extracellular microRNAs are shown to modulate nociceptive transmission. Furthermore, extracellular non–coding RNAs are expected as a specific biomarker for neuronal damage or pain in the blood. In this review, we summarize current insights into non–coding RNA significance in the neuropathic pain.
非编码RNA通过与DNA、RNA和蛋白质的相互作用影响各种细胞过程。因此,非编码RNA、微小RNA和最近的长非编码RNA已被证明与疼痛障碍有关,包括神经性疼痛。微小RNA抑制基因表达的翻译步骤,微小RNA的失调是神经性疼痛的基础。另一方面,lncRNA调节基因表达的不同步骤,包括表观遗传学调节、转录、选择性剪接和翻译,尽管lncRNA在疼痛障碍中的作用仍知之甚少。有趣的是,一部分非编码RNA被释放到细胞外空间,并介导细胞间的通讯。细胞外微小RNA被证明可以调节伤害性传递。此外,细胞外非编码RNA有望成为血液中神经元损伤或疼痛的特异性生物标志物。在这篇综述中,我们总结了非编码RNA在神经性疼痛中的意义。
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引用次数: 1
Analysis of the relationship between knee osteoarthritis weight–bearing pain and transient receptor potential vanilloid 1 using the CatWalk system 利用CatWalk系统分析膝关节骨关节炎负重痛与瞬时受体电位香草蛋白1的关系
Pub Date : 2019-09-20 DOI: 10.11154/pain.34.247
W. Taniguchi, N. Nishio, Manabu Yamanaka, R. Taiji, S. Tsutsui, T. Nakatsuka, H. Yamada
Osteoarthritis of the knee (knee OA) is a common disease in the elderly, and the chief complaint of these patients is knee pain. Knee OA pain reduces the activities of daily living and the quality of life in these patients. The degree of pain does not correlate with radiographic grades, and the intense wear of the cartilage does not neces sarily mean intense pain. However, the cellular mechanism of chronic pain in this disease has been unclear. This study aimed to investigate the effects of the transient receptor potential vanilloid 1 (TRPV 1 ) on weight–bearing pain–related behaviors in knee OA model rats using the CatWalk system. To generate the knee OA model, monosodium iodoacetate (MIA) was injected in the right knee joint of male adult Sprague–Dawley rats. Four weeks after the MIA injection, we used the knee OA rats for the behavioral study. Using the CatWalk system, we investigated the effects of the intra–articular injection of the TRPV 1 selective agonist capsaicin, TRPV 1 selective antagonist capsazepine, and saline on the nociceptive behaviors of the rats with knee OA at 1 , 2 , 7 , and 10 days after the intra–articular injection. The rats treated with intra–articular capsazepine injection showed significantly greater improvement in swing speed, a pain–related behavioral parameter of the CatWalk system, than those treated with capsaicin on day 2 after injection. The maximum contact area on day 10 showed significantly greater improvement in the capsazepine group than in the capsaicin group. These results suggest that TRPV 1 is an important contributor to weight–bearing pain–related behavior of patients with knee OA. However, in this study, these effects were observed at later time points. Thus, TRPV 1 could be related to not only the peripheral nociceptive pain mechanism, but also to the secondary pain mechanism.
膝关节骨关节炎(膝OA)是老年人的常见病,这些患者的主诉是膝关节疼痛。膝关节炎疼痛降低了这些患者的日常生活活动和生活质量。疼痛的程度与放射分级无关,软骨的剧烈磨损并不一定意味着剧烈疼痛。然而,慢性疼痛在这种疾病中的细胞机制尚不清楚。本研究旨在通过CatWalk系统研究瞬时受体电位香草素1 (TRPV 1)对膝关节OA模型大鼠负重疼痛相关行为的影响。采用雄性成年sd大鼠右膝关节注射碘乙酸钠(MIA)制备膝关节OA模型。注射MIA 4周后,我们用膝关节OA大鼠进行行为学研究。使用CatWalk系统,我们研究了关节内注射TRPV - 1选择性激动剂辣椒素、TRPV - 1选择性拮抗剂辣椒平和生理盐水对关节内注射后1、2、7和10天膝关节OA大鼠伤害性行为的影响。在注射后第2天,关节内注射辣椒素的大鼠在摆动速度(与疼痛相关的猫步系统行为参数)方面的改善显著高于注射辣椒素的大鼠。第10天最大接触面积的改善,辣椒素组明显大于辣椒素组。这些结果表明,TRPV - 1是膝关节OA患者负重疼痛相关行为的重要因素。然而,在这项研究中,这些影响是在后来的时间点观察到的。因此,TRPV - 1不仅与外周痛觉性疼痛机制有关,还可能与继发性疼痛机制有关。
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引用次数: 1
Multidisciplinary inpatient pain management program for chronic musculoskeletal pain 慢性肌肉骨骼疼痛的多学科住院疼痛管理项目
Pub Date : 2019-03-30 DOI: 10.11154/PAIN.34.44
N. Takahashi, S. Kasahara, S. Yabuki
Multidisciplinary pain management is one of the useful methods for the treatment of chronic musculoskeletal pain, as has been demonstrated in the USA since 1950s. A biopsychosocial model of well–being is a very important concept in the multidisciplinary treatment. This model is a general model or approach stating that biological, psycho logical, and social factors play a significant role in human functioning in the context of disease or illness. Currently there are few facilities in Japan that administer a multidisciplinary pain treatment, especially an inpatient pain management program. We are implementing a multidisciplinary pain management program based on biopsychosocial model guided by the IASP recommendations for such a program in Fukushima, Japan. The purpose of this study was to describe our initial efforts in creating a Japanese inpatient pain management program using the biopsychosocial method of self–pain management. The pain management center was started in April 2015 with a team consisting of ortho paedic surgeons, psychiatrists, nurses, physical therapists, clinical psychologists, pharmacists, and nutritionists. Our 3–week inpatient pain management program is indicated for patients who find it hard to work or go to school due to chronic musculoskeletal pain, and/or are confined to life at home but want to return to work or school. This program consists of exercise therapy, psychotherapy, and cognitive behavior al therapy. Using this program, our inpatients with intractable chronic muscu loskeletal pain were evaluated using brief pain inventory (BPI), pain catastrophizing scale (PCS) (rumination, magnification, and helplessness), pain disability assessment scale (PDAS), hospital anxiety and depression scale (HADS), pain self– efficacy questionnaire (PSEQ), EQ–5D, and physical functions (flexibility, muscle endurance, walking ability, and physical fitness). Statistical analyses were performed using the paired t–test and Wilcoxon matched pairs signed rank sum test with Bonferroni correction after Friedman test. Twenty–one patients (7 male and 14 female; 20–79 years old (Average 52.2 years old)) were analyzed from April 2015 to December 2017. Comparing results before and after the program, the following statistically significant improvement were seen in BPI, PCS (rumination, magnification, helplessness), PDAS, HADS anxiety and depression scale, PSEQ, EQ–5D, 30–sec sit to stand test (muscle endurance), 2 step test (walking ability), and 6–minute walking test
多学科疼痛管理是治疗慢性肌肉骨骼疼痛的有用方法之一,自20世纪50年代以来,美国就已经证明了这一点。在多学科治疗中,幸福的生物-心理-社会模型是一个非常重要的概念。该模型是一种通用模型或方法,说明生物、心理和社会因素在疾病或疾病背景下对人类功能发挥着重要作用。目前,日本很少有机构进行多学科疼痛治疗,尤其是住院疼痛管理项目。我们正在日本福岛实施一项基于生物心理社会模型的多学科疼痛管理计划,该计划遵循IASP的建议。本研究的目的是描述我们使用自我疼痛管理的生物心理社会方法创建日本住院患者疼痛管理计划的最初努力。疼痛管理中心成立于2015年4月,其团队由整形外科医生、精神科医生、护士、物理治疗师、临床心理学家、药剂师和营养学家组成。我们的3周住院疼痛管理计划适用于因慢性肌肉骨骼疼痛而难以工作或上学的患者,和/或只能在家生活但想重返工作或学校的患者。该项目包括运动治疗、心理治疗和认知行为治疗。使用该程序,我们使用简短疼痛量表(BPI)、疼痛灾难量表(PCS)(沉思、放大和无助)、疼痛残疾评估量表(PDAS)、医院焦虑和抑郁量表(HADS)、疼痛自我效能问卷(PSEQ)、EQ-5D,以及身体功能(灵活性、肌肉耐力、行走能力和身体素质)。使用配对t检验和Wilcoxon配对符号秩和检验进行统计分析,并在Friedman检验后进行Bonferroni校正。分析了2015年4月至2017年12月的21名患者(7名男性和14名女性;20-79岁(平均52.2岁))。比较项目前后的结果,在BPI、PCS(沉思、放大、无助)、PDAS、HADS焦虑和抑郁量表、PSEQ、EQ-5D、30秒坐立测试(肌肉耐力)、2步测试(行走能力)和6分钟行走测试中,发现以下具有统计学意义的改善
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引用次数: 0
Mechanisms of distorted body representation and neurorehabilitation 扭曲的身体表征机制与神经康复
Pub Date : 2019-03-30 DOI: 10.11154/PAIN.34.10
S. Morioka
Phantom limb refers to a phenomenon whereby the patient still feels sensation and movements originating in the missing part after amputation. The patient is therefore aware of a part of the body that does not actually exist. The patient may also experience pain at this site, despite the actual body part not existing. Such a condition is referred to as phantom limb pain. Asomatognosia, however, refers to loss of awareness of a part of the body. It is a state in which the patient’s awareness of their body differs from reality. While this condition is normally widely–recognized as occurring after brain injury and right hemisphere damage in particular, it has been found to occur in many cases of neuropathic pain such as complex regional pain syndrome. In such cases, these are termed neglect–like symptoms. Thus, physical modification such as declines in sense of ownership and sense of agency may also be noted in motor disorders. Such cases involve dysfunction of the parietal lobe, which is involved in body representation. Therefore, in recent years, techniques for approaches to brain dysfunction similar to rehabilitation for stroke patients have been developed for cases of phantom limb not associated with brain damage and cases of motor disorders. The effects of such techniques are gradually being demonstrated. In this review, we described distorted body representation mechanisms from the viewpoints of neuro -phenomenology, neuropsychology and neurophysiology, and present the newly developed technique termed neurorehabilitation.
幻肢是指患者在截肢后仍能感受到源自缺失部位的感觉和运动的现象。因此,病人意识到身体的一部分实际上并不存在。患者也可能在这个部位感到疼痛,尽管实际的身体部位不存在。这种情况被称为幻肢痛。然而,Asomatognosia指的是失去对身体某一部分的意识。这是一种病人对自己身体的认知与现实不同的状态。虽然这种情况通常被广泛认为发生在脑损伤,特别是右半球损伤之后,但它也被发现发生在许多神经性疼痛的病例中,如复杂的局部疼痛综合征。在这种情况下,这些被称为忽视样症状。因此,身体上的改变,如所有权感和代理感的下降,也可能在运动障碍中被注意到。这些病例包括顶叶功能障碍,这与身体表征有关。因此,近年来,针对与脑损伤无关的幻肢和运动障碍的病例,开发了类似于卒中患者康复的脑功能障碍治疗方法。这些技术的效果正在逐渐得到证实。本文从神经现象学、神经心理学和神经生理学的角度阐述了扭曲的身体表征机制,并介绍了新发展的神经康复技术。
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引用次数: 0
Functional and structural brain changes in patients with phantom limb pain 幻肢疼痛患者大脑功能和结构的变化
Pub Date : 2019-03-30 DOI: 10.11154/PAIN.34.1
S. Kan
Phantom limb is a sensation of a missing hand that patients feel after amputation, and phantom limb pain or phantom pain is a pain in a phantom limb. Phantom limb pain occurs in 45 % – 85 % of amputees, and a part of them becomes refractory. Thus, it is needed to fully understand the pathophysiology of phantom limb pain for the devel-opment of effective treatments. To elucidate the central mechanisms of phantom limb pain, functional and anatomical changes in the brain has been explored by using non– invasive brain activity recording technique such as electroencephalography (EEG), magnetoencephalography (MEG) and functional magnetic resonance imaging (fMRI). In 1995 , Flor and colleagues reported that the somatotopic organization of the primary somatosensory cortex had altered in patients with phantom limb pain and the magnitude of this alteration had been associated with the intensity of their phantom limb pain. Based on these results, they proposed a model that alterations in the somatotopic organization of a missing hand are involved in phantom limb pain. Now, this model is known as the maladaptive reorganization model. Over the following 20 years, a variety of supporting evidence has been provided, and this model has been widely accepted. However, Makin and colleagues provided evidence against this model in 2013 . They demonstrated that cortical representation of a missing hand had been preserved and activation evoked by phantom limb movement had been related to the severity of phantom limb pain. After that, the maladaptive reorganization model has been revisited, and recent studies have suggested that functional alterations in the primary motor cortex rather than the primary sensory cortex are associated with phantom limb pain. Most recently, by using brain–machine interface technology, Yanagisawa and colleagues demonstrated that the activity of the missing hand area in the sensorimotor cortex is closely related to phantom limb pain. However, detailed neural mechanisms of phantom limb pain remain unclear so far, although many changes in the peripheral
幻肢是患者在截肢后感觉到的手缺失的感觉,幻肢疼痛或幻痛是幻肢的疼痛。45%-85%的截肢者会出现幻肢疼痛,其中一部分会变得难以治疗。因此,需要充分了解幻肢疼痛的病理生理学,以开发有效的治疗方法。为了阐明幻肢疼痛的中心机制,通过使用非侵入性脑活动记录技术,如脑电图(EEG)、脑磁图(MEG)和功能磁共振成像(fMRI),探索了大脑的功能和解剖变化。1995年,Flor及其同事报告称,幻肢疼痛患者初级体感皮层的躯体主题组织发生了变化,这种变化的程度与幻肢疼痛的强度有关。基于这些结果,他们提出了一个模型,即缺失手的躯体主题组织的改变与幻肢疼痛有关。现在,这种模型被称为不适应重组模型。在接下来的20年里,提供了各种支持证据,这种模式已被广泛接受。然而,Makin及其同事在2013年提供了反对这种模式的证据。他们证明,缺失手的皮层表现得到了保留,幻肢运动引起的激活与幻肢疼痛的严重程度有关。之后,人们重新审视了适应不良的重组模型,最近的研究表明,初级运动皮层而不是初级感觉皮层的功能改变与幻肢疼痛有关。最近,柳泽及其同事通过使用脑机接口技术证明了感觉运动皮层中缺失的手部区域的活动与幻肢疼痛密切相关。然而,到目前为止,幻肢疼痛的详细神经机制尚不清楚,尽管外周神经发生了许多变化
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Pain Research
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