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Influence of Frailty Status on the Efficacy of Epidural Steroid Injections in Elderly Patients With Degenerative Lumbar Spinal Disease. 虚弱状态对腰椎退行性疾病老年患者硬膜外类固醇注射疗效的影响
Pub Date : 2024-09-07 DOI: 10.1155/2024/5038496
Hee Jung Kim,Ho Jae Nam,Shin Hyung Kim
Background: The global increase in the elderly population has led to a higher prevalence of degenerative lumbar spinal diseases. Epidural steroid injection (ESI) is a widely used procedure for managing lower back pain. This study investigated the association of preprocedural frailty status with the efficacy of ESI in elderly patients diagnosed with degenerative lumbar spinal diseases. Methods: This retrospective observational study included patients aged 65 years and older who underwent lumbar ESI. Frailty status (robust, prefrail, and frail) assessed via the Frailty Phenotype Questionnaire was collected along with demographic and clinical parameters. Good analgesia was defined as a ≥ 50% reduction in pain score at 4-week follow-up evaluation. Multivariable logistic regression analyses were performed to identify factors associated with poor analgesia. Results: We included 289 patients in this study. Frailty status correlated with analgesic outcomes, with worsening frailty status correlating with increasingly poor analgesia after the injection (robust = 34.5%, prefrail = 40.8%, and frail = 60.0%, p=0.003), predominantly in female patients. After adjusting for demographic and clinical factors, frail patients demonstrated much higher odds of poor analgesia than robust individuals (adjusted odds ratio [aOR] = 2.673, 95% confidence interval [CI] = 1.338-5.342, p=0.005). Conversely, prefrail patients did not show a significant association with analgesic outcome (aOR = 1.293, 95% CI = 0.736-2.272, p=0.372). Conclusions: Frailty, but not prefrailty, appeared to be an independent factor associated with poor analgesic efficacy of ESI in elderly patients with symptomatic degenerative lumbar spinal disease receiving conservative care.
背景:随着全球老年人口的增加,腰椎退行性疾病的发病率也越来越高。硬膜外类固醇注射(ESI)是一种广泛用于治疗下背痛的方法。本研究探讨了在确诊为腰椎退行性疾病的老年患者中,术前体弱状况与 ESI 疗效的关系。研究方法这项回顾性观察研究纳入了接受腰椎ESI手术的65岁及以上患者。通过 "虚弱表型问卷 "评估患者的虚弱状态(健壮、虚弱前和虚弱),同时收集人口统计学和临床参数。在四周的随访评估中,疼痛评分降低≥50%即为镇痛良好。进行了多变量逻辑回归分析,以确定与镇痛效果不佳相关的因素。研究结果本研究共纳入 289 名患者。虚弱状态与镇痛效果相关,虚弱状态恶化与注射后镇痛效果越来越差相关(强壮=34.5%,虚弱前=40.8%,虚弱=60.0%,P=0.003),女性患者居多。在对人口统计学和临床因素进行调整后,体弱患者出现镇痛不良的几率远远高于健壮患者(调整后的几率比 [aOR] = 2.673,95% 置信区间 [CI] = 1.338-5.342,p=0.005)。相反,前倾型患者与镇痛结果无明显关联(aOR = 1.293,95% CI = 0.736-2.272,p=0.372)。结论对于接受保守治疗的无症状退行性腰椎病老年患者来说,体弱似乎是导致ESI镇痛效果不佳的一个独立因素,而不是先天性体弱。
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引用次数: 0
Efficacy and Safety of Pulsed Radiofrequency of Dorsal Root Ganglion in Elderly Patient Population With Acute and Subacute Zoster-Related Pain. 带状疱疹急性和亚急性疼痛老年患者背根神经节脉冲射频治疗的有效性和安全性
Pub Date : 2024-09-06 DOI: 10.1155/2024/6586167
Gözde Dağıstan,Serdar Erdine
Background: Herpes zoster (HZ) is typically characterized by a burning, stabbing pain, hyperalgesia, and allodynia. In some patients, despite the lesions resolving, the pain persists and becomes chronic. If the pain continues for more than 6 months after the onset of the pain phase, this condition is called postherpetic neuralgia (PHN). The frequency and severity of PHN increase with advancing age. The pain in PHN can be severe, sometimes resistant to medications, significantly impacting the patients' quality of life. The elderly patient population cannot tolerate the medications due to their side effects. In this situation, interventional pain treatment should be applied in the elderly patient group who have a high risk of developing PHN compared to other age groups. Method: We included patients over 65 years of age with HZ-related pain who underwent dorsal root ganglion (DRG) pulsed radiofrequency (PRF) within the first 6 months from the onset of pain. We divided these patients into 2 groups: patients who underwent intervention within the first 1 month from the onset of pain and patients who underwent intervention between 1 and 6 months. We recorded medication doses and Numeric Rating Scale (NRS) scores before the procedure and at 1 week, 1 month, 3 months, and 6 months after the procedure. Results: After the DRG PRF treatment, NRS scores improved significantly in both groups (p < 0.05). The mean NRS score in the early DRG PRF group was significantly lower than that in the late DRG PRF group (p < 0.05). The medication doses in the early DRG PRF group were significantly lower than those in the other group (p < 0.05). Conclusions: Interventional pain treatment should be applied as soon as possible in the elderly patient group who do not respond to first-line medical treatment or cannot tolerate medical treatment due to its side effects and who have a high risk of developing PHN compared to other age groups. DRG PRF, applied in the early period of medical treatment-resistant acute HZ, is safe and effective, preventing the progression to PHN.
背景:带状疱疹(HZ)的典型特征是烧灼感、刺痛、痛觉减退和异动症。在一些患者中,尽管皮损已经消退,但疼痛仍会持续并转为慢性。如果疼痛阶段开始后持续 6 个月以上,这种情况被称为带状疱疹后遗神经痛(PHN)。随着年龄的增长,PHN 的发病率和严重程度也会增加。PHN 的疼痛可能很剧烈,有时会对药物产生抗药性,严重影响患者的生活质量。由于药物的副作用,老年患者无法耐受药物。在这种情况下,与其他年龄组相比,老年患者患 PHN 的风险较高,因此应采用介入疼痛治疗。方法:我们纳入了 65 岁以上的 HZ 相关疼痛患者,这些患者在疼痛发生后 6 个月内接受了背根神经节(DRG)脉冲射频(PRF)治疗。我们将这些患者分为两组:在疼痛发生后 1 个月内接受干预的患者和在 1 至 6 个月内接受干预的患者。我们记录了手术前以及手术后 1 周、1 个月、3 个月和 6 个月的药物剂量和数字评定量表 (NRS) 评分。结果DRG PRF 治疗后,两组患者的 NRS 评分均有明显改善(P < 0.05)。早期 DRG PRF 组的平均 NRS 评分明显低于晚期 DRG PRF 组(P < 0.05)。早期 DRG PRF 组的药物剂量明显低于其他组(P < 0.05)。结论与其他年龄组相比,老年患者对一线药物治疗无反应或因药物治疗的副作用而无法耐受药物治疗,且罹患 PHN 的风险较高,因此应尽早采用介入疼痛治疗。在对药物治疗耐药的急性 HZ 早期应用 DRG PRF 是安全有效的,可防止发展为 PHN。
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引用次数: 0
Reduced Fascicle Area Demonstrated in Ilioinguinal Nerves Resected from Primary Inguinal Herniorrhaphy Patients as Evidence of Compression Neuropathy 从原发性腹股沟疝切除的髂腹股沟神经中显示的筋膜面积减少是压迫性神经病变的证据
Pub Date : 2024-05-20 DOI: 10.1155/2024/3339753
Robert Wright, Donald E. Born, Troy Sanders, Jordan Landes, Troy Salisbury, Anjali S. Kumar, Makena Horne
Background and Aim. Previous studies have reported 63% of primary inguinal hernia patients present with apparent enlargement of the ilioinguinal nerve beyond the inguinal ring. This may be due to hernia-related pressure on the canal portion of the ilioinguinal nerve, a form of compression neuropathy. The ilioinguinal nerve of 30 patients was resected near the external inguinal ring during herniorrhaphy and histologically characterized to investigate the underlying cause of the size discrepancy. Methods. 30 male patients with primary inguinal hernias undergoing primary inguinal herniorrhaphy were prospectively recruited for ilioinguinal nerve resection and evaluation. Three samples of the resected ilioinguinal nerve (proximal, canal, and distal) were evaluated using Masson’s trichrome stain to measure fascicle and total nerve cross-sectional area and detect changes in collagen. Results. The fascicle cross-sectional area in the canal segment was significantly decreased compared to the proximal control with a large effect size observed (p=0.016,η2 =0.16). There was no significant difference in the nerve cross-sectional area between locations, but there was a moderate to large effect size observed between locations (p=0.165,η2 =0.105). There was no significant difference in collagen content nor effect size observed between locations (p=0.99,η2 =1.503×10−4). Interpretation. The decrease in the fascicle cross-sectional area within the inguinal canal further suggests that there is chronic pressure applied by hernia tissue consistent with axon degeneration. Collagen content is uniformly distributed along the length of the nerve. Further studies with larger samples are needed to confirm the observed effect of nerve location on the total nerve cross-sectional area and axon loss.
背景和目的。先前的研究报告显示,63% 的原发性腹股沟疝患者的髂腹股沟神经明显增大,超过了腹股沟环。这可能是由于髂腹股沟神经的管状部分受到与疝相关的压力,是一种压迫性神经病变。在进行疝切除术时,我们在腹股沟外环附近切除了 30 例患者的髂腹股沟神经,并对其进行了组织学鉴定,以研究造成大小不一的根本原因。方法前瞻性地招募了 30 名接受原发性腹股沟疝切除术的原发性腹股沟疝男性患者,对他们的髂腹股沟神经进行切除和评估。使用马森三色染色法对切除的髂腹股沟神经的三个样本(近端、管状和远端)进行评估,以测量神经束和神经总横截面积,并检测胶原蛋白的变化。结果与近端对照组相比,管节段的神经束横截面积明显减少,且效应大小较大(p=0.016,η2 =0.16)。不同位置之间的神经横截面积没有明显差异,但不同位置之间存在中度到大型效应(p=0.165,η2 =0.105)。不同位置之间的胶原蛋白含量和效应大小均无明显差异(p=0.99,η2 =1.503×10-4)。释义腹股沟管内筋膜横截面积的减少进一步表明,疝组织施加的慢性压力与轴突变性一致。胶原含量沿神经长度均匀分布。需要对更大的样本进行进一步研究,以证实所观察到的神经位置对神经总横截面积和轴突损失的影响。
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引用次数: 0
The Causal Relationship between Angina Pectoris and Gout Based on Two Sample Mendelian Randomization 基于双样本孟德尔随机法的心绞痛与痛风之间的因果关系
Pub Date : 2024-04-09 DOI: 10.1155/2024/4564596
Jian Xiong, Yuxin Sun, Hui Huang, Yu Liu, Fayang Ling, Yin Wei, Qianhua Zheng, Wenchuan Qi, Fanrong Liang
Purpose. Two-sample Mendelian randomization (MR) was conducted to assess the causal relationship between angina pectoris and gout. Material and Methods. Based on genome-wide association studies, single nucleotide polymorphisms (SNPs) that were closely associated with gout were selected from the UK Biobank–Neale Lab (ukb-a-107) as genetic instrumental variables. Considering that gout is characterized by elevated blood uric acid levels, SNPs related to blood uric acid levels were screened from BioBank Japan (bbj-a-57) as auxiliary gene instrumental variables. SNPs closely associated with angina pectoris onset were screened from the FINN dataset (finn-b-I9_ANGINA) as outcome variables. Two-sample MR was conducted, with inverse variance weighting (IVW) of the random effects model as the primary result, along with the weighted median method (WME) and the MR-Egger regression method. To further confirm the causal relationship between angina and gout incidence, a meta-analysis was conducted on the IVW results of the ukb-a-107 and bbj-a-57. Results. The odds ratios and 95% confidence intervals of the IVW, WME, and MR-Egger results of ukb-a-107 were (OR = 33.72; 95% CI: 2.07∼550.38), (OR = 57.94; 95% CI: 2.75∼1219.82), and (OR = 96.38; 95% CI: 0.6∼15556.93), respectively. The values of IVW and WME were 0.014 and 0.014 (both <0.05), respectively, indicating that the development of angina pectoris was significantly associated with the incidence of gout. The odds ratios and 95% confidence intervals of the IVW, WME, and MR-Egger about bbj-a-57 were (OR = 1.20; 95% CI: 1.07∼1.34), (OR = 1.19; 95% CI: 1.02∼1.38), and (OR = 1.30; 95% CI; 1.06∼1.60), respectively. The values of IVW, WME and MR-Egger were 0.001, 0.027 and 0.017 (all <0.05), respectively, indicating a significant correlation between angina and blood uric acid levels. Scatter plots of ukb-a-107 and bbj-a-57 showed that the causal association estimates of the IVW, MR-Egger, and weighted median methods were similar and that the MR results were accurate. Funnel plots and the MR-Egger intercept of ukb-a-107 and bbj-a-57 showed the absence of horizontal pleiotropy. The leave-out sensitivity analysis results of ukb-a-107 and bbj-a-57 are stable. The meta-analysis of IVW results for ukb-a-107 and bbj-a-57 showed (OR = 1.20; 95% CI: 1.07–1.34,
研究目的采用双样本孟德尔随机法(MR)评估心绞痛与痛风之间的因果关系。材料和方法。根据全基因组关联研究,从英国生物库-尼尔实验室(ukb-a-107)中筛选出与痛风密切相关的单核苷酸多态性(SNPs)作为遗传工具变量。考虑到痛风的特征是血尿酸水平升高,因此从日本生物库(bbj-a-57)中筛选出与血尿酸水平相关的 SNPs 作为辅助基因工具变量。从 FINN 数据集(finn-b-I9_ANGINA)中筛选出与心绞痛发病密切相关的 SNPs 作为结果变量。采用随机效应模型的反方差加权法(IVW)以及加权中值法(WME)和 MR-Egger 回归法进行了双样本 MR 分析。为进一步证实心绞痛与痛风发病率之间的因果关系,对ukb-a-107 和 bbj-a-57 的 IVW 结果进行了荟萃分析。结果显示ukb-a-107的IVW、WME和MR-Egger结果的几率比和95%置信区间分别为(OR = 33.72; 95% CI: 2.07∼550.38)、(OR = 57.94; 95% CI: 2.75∼1219.82)和(OR = 96.38; 95% CI: 0.6∼15556.93)。IVW和WME的值分别为0.014和0.014(均为<0.05),表明心绞痛的发生与痛风的发病率显著相关。关于bbj-a-57的IVW、WME和MR-Egger的几率比和95%置信区间分别为(OR = 1.20; 95% CI: 1.07∼1.34)、(OR = 1.19; 95% CI: 1.02∼1.38)和(OR = 1.30; 95% CI; 1.06∼1.60)。IVW、WME和MR-Egger的值分别为0.001、0.027和0.017(均为<0.05),表明心绞痛与血尿酸水平之间存在显著相关性。ukb-a-107和bbj-a-57的散点图显示,IVW、MR-Egger和加权中值法的因果关联估计值相似,MR结果准确。ukb-a-107和bbj-a-57的漏斗图和MR-Egger截距显示不存在水平多效性。ukb-a-107和bbj-a-57的剔除敏感性分析结果稳定。ukb-a-107和bbj-a-57的IVW荟萃分析结果显示(OR = 1.20; 95% CI: 1.07-1.34, ),证实了以高血尿酸水平为特征的痛风会显著增加心绞痛发作的风险。结论这项磁共振研究发现,心绞痛与痛风之间存在明显的因果关系,痛风会增加心绞痛发作的风险。
{"title":"The Causal Relationship between Angina Pectoris and Gout Based on Two Sample Mendelian Randomization","authors":"Jian Xiong, Yuxin Sun, Hui Huang, Yu Liu, Fayang Ling, Yin Wei, Qianhua Zheng, Wenchuan Qi, Fanrong Liang","doi":"10.1155/2024/4564596","DOIUrl":"https://doi.org/10.1155/2024/4564596","url":null,"abstract":"<i>Purpose</i>. Two-sample Mendelian randomization (MR) was conducted to assess the causal relationship between angina pectoris and gout. <i>Material and Methods</i>. Based on genome-wide association studies, single nucleotide polymorphisms (SNPs) that were closely associated with gout were selected from the UK Biobank–Neale Lab (ukb-a-107) as genetic instrumental variables. Considering that gout is characterized by elevated blood uric acid levels, SNPs related to blood uric acid levels were screened from BioBank Japan (bbj-a-57) as auxiliary gene instrumental variables. SNPs closely associated with angina pectoris onset were screened from the FINN dataset (finn-b-I9_ANGINA) as outcome variables. Two-sample MR was conducted, with inverse variance weighting (IVW) of the random effects model as the primary result, along with the weighted median method (WME) and the MR-Egger regression method. To further confirm the causal relationship between angina and gout incidence, a meta-analysis was conducted on the IVW results of the ukb-a-107 and bbj-a-57. <i>Results</i>. The odds ratios and 95% confidence intervals of the IVW, WME, and MR-Egger results of ukb-a-107 were (OR = 33.72; 95% CI: 2.07∼550.38), (OR = 57.94; 95% CI: 2.75∼1219.82), and (OR = 96.38; 95% CI: 0.6∼15556.93), respectively. The <svg height=\"8.68572pt\" style=\"vertical-align:-0.0498209pt\" version=\"1.1\" viewbox=\"-0.0498162 -8.6359 8.15071 8.68572\" width=\"8.15071pt\" xmlns=\"http://www.w3.org/2000/svg\" xmlns:xlink=\"http://www.w3.org/1999/xlink\"><g transform=\"matrix(.013,0,0,-0.013,0,0)\"></path></g></svg> values of IVW and WME were 0.014 and 0.014 (both &lt;0.05), respectively, indicating that the development of angina pectoris was significantly associated with the incidence of gout. The odds ratios and 95% confidence intervals of the IVW, WME, and MR-Egger about bbj-a-57 were (OR = 1.20; 95% CI: 1.07∼1.34), (OR = 1.19; 95% CI: 1.02∼1.38), and (OR = 1.30; 95% CI; 1.06∼1.60), respectively. The <svg height=\"8.68572pt\" style=\"vertical-align:-0.0498209pt\" version=\"1.1\" viewbox=\"-0.0498162 -8.6359 8.15071 8.68572\" width=\"8.15071pt\" xmlns=\"http://www.w3.org/2000/svg\" xmlns:xlink=\"http://www.w3.org/1999/xlink\"><g transform=\"matrix(.013,0,0,-0.013,0,0)\"><use xlink:href=\"#g113-81\"></use></g></svg> values of IVW, WME and MR-Egger were 0.001, 0.027 and 0.017 (all &lt;0.05), respectively, indicating a significant correlation between angina and blood uric acid levels. Scatter plots of ukb-a-107 and bbj-a-57 showed that the causal association estimates of the IVW, MR-Egger, and weighted median methods were similar and that the MR results were accurate. Funnel plots and the MR-Egger intercept of ukb-a-107 and bbj-a-57 showed the absence of horizontal pleiotropy. The leave-out sensitivity analysis results of ukb-a-107 and bbj-a-57 are stable. The meta-analysis of IVW results for ukb-a-107 and bbj-a-57 showed (OR = 1.20; 95% CI: 1.07–1.34, <span><svg height=\"8.8423pt\" style=\"vertical-align:-0.2064009pt\" version","PeriodicalId":501829,"journal":{"name":"Pain Research and Management","volume":"26 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140600960","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Efficacy and Safety of Computed Tomography-Guided Percutaneous Balloon Compression under Local Anesthesia for Recurrent Trigeminal Neuralgia: A Prospective Study 局部麻醉下计算机断层扫描引导的经皮球囊压迫治疗复发性三叉神经痛的有效性和安全性:前瞻性研究
Pub Date : 2024-04-09 DOI: 10.1155/2024/8885274
Lulu Xi, Xiaohui Liu, Hongchen Shi, Wenbiao Han, Liqin Gao, Li Wang, Junpeng Liu, Yue Ren, Yuanyuan Du, Guangzhao Liu
Purpose. There are several ways to treat trigeminal neuralgia (TN); however, TN may recur after treatment. This study investigated the efficacy and safety of computed tomography (CT)-guided percutaneous balloon compression (PBC) under local anesthesia for treatment of recurrent trigeminal neuralgia. Patients and Methods. This is a prospective and nonrandomized controlled clinical study. Forty-eight patients with classical TN were scheduled to undergo PBC surgery at the pain department of our institution between January 2021 and June 2021. The patients were prospectively divided into an initial onset group, A (21 cases), and a recurrence group, B (27 cases). All surgeries were performed with CT guidance and under local anesthesia. Postoperative complications were also observed. Pain was assessed using the visual analog scale (VAS) and Barrow Neurological Institute (BNI) scale. Efficacy indices were evaluated at 3, 6, 12, and 18 months after surgery. Results. All participants reported complete pain relief at discharge. After 18 months of follow-up, the total effective rate of pain control was 89.5% (group A, 90.5%; group B, 88.8%). There was no significant difference in the BNI scores between the two groups before and after treatment. All patients had hypoesthesia on the affected side, and no severe complications such as diplopia, blindness, intracranial hemorrhage, or intracranial infection occurred. Conclusions. CT-guided PBC under local anesthesia is safe and effective for the treatment of recurrent TN and thus acts as an effective alternative for geriatric patients and those with high-risk factors.
目的。治疗三叉神经痛(TN)有多种方法,但治疗后可能复发。本研究探讨了在局部麻醉下使用计算机断层扫描(CT)引导的经皮球囊压迫术(PBC)治疗复发性三叉神经痛的有效性和安全性。患者和方法。这是一项前瞻性非随机对照临床研究。48例典型TN患者计划于2021年1月至2021年6月期间在我院疼痛科接受PBC手术。这些患者被前瞻性地分为初次发病组 A(21 例)和复发组 B(27 例)。所有手术均在 CT 引导和局部麻醉下进行。同时还观察了术后并发症。疼痛采用视觉模拟量表(VAS)和巴罗神经研究所(BNI)量表进行评估。疗效指数在术后 3、6、12 和 18 个月进行评估。结果。所有参与者在出院时均报告疼痛完全缓解。随访 18 个月后,疼痛控制总有效率为 89.5%(A 组为 90.5%;B 组为 88.8%)。两组患者在治疗前后的 BNI 评分无明显差异。所有患者的患侧均有麻木感,未出现复视、失明、颅内出血或颅内感染等严重并发症。结论在局部麻醉下进行CT引导下PBC治疗复发性TN安全有效,是老年患者和高危人群的有效选择。
{"title":"Efficacy and Safety of Computed Tomography-Guided Percutaneous Balloon Compression under Local Anesthesia for Recurrent Trigeminal Neuralgia: A Prospective Study","authors":"Lulu Xi, Xiaohui Liu, Hongchen Shi, Wenbiao Han, Liqin Gao, Li Wang, Junpeng Liu, Yue Ren, Yuanyuan Du, Guangzhao Liu","doi":"10.1155/2024/8885274","DOIUrl":"https://doi.org/10.1155/2024/8885274","url":null,"abstract":"<i>Purpose</i>. There are several ways to treat trigeminal neuralgia (TN); however, TN may recur after treatment. This study investigated the efficacy and safety of computed tomography (CT)-guided percutaneous balloon compression (PBC) under local anesthesia for treatment of recurrent trigeminal neuralgia. <i>Patients and Methods</i>. This is a prospective and nonrandomized controlled clinical study. Forty-eight patients with classical TN were scheduled to undergo PBC surgery at the pain department of our institution between January 2021 and June 2021. The patients were prospectively divided into an initial onset group, A (21 cases), and a recurrence group, B (27 cases). All surgeries were performed with CT guidance and under local anesthesia. Postoperative complications were also observed. Pain was assessed using the visual analog scale (VAS) and Barrow Neurological Institute (BNI) scale. Efficacy indices were evaluated at 3, 6, 12, and 18 months after surgery. <i>Results</i>. All participants reported complete pain relief at discharge. After 18 months of follow-up, the total effective rate of pain control was 89.5% (group A, 90.5%; group B, 88.8%). There was no significant difference in the BNI scores between the two groups before and after treatment. All patients had hypoesthesia on the affected side, and no severe complications such as diplopia, blindness, intracranial hemorrhage, or intracranial infection occurred. <i>Conclusions</i>. CT-guided PBC under local anesthesia is safe and effective for the treatment of recurrent TN and thus acts as an effective alternative for geriatric patients and those with high-risk factors.","PeriodicalId":501829,"journal":{"name":"Pain Research and Management","volume":"37 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140601221","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Myofascial Release for the Treatment of Tension-Type, Cervicogenic Headache or Migraine: A Systematic Review and Meta-Analysis 治疗紧张型颈源性头痛或偏头痛的肌筋膜松解术:系统回顾与元分析
Pub Date : 2024-03-31 DOI: 10.1155/2024/2042069
Zhoupeng Lu, Hui Zou, Peng Zhao, Jialin Wang, Ruirui Wang
Objective. To assess the effectiveness of myofascial release (MFR) techniques on the intensity of headache pain and associated disability in patients with tension-type headache (TTH), cervicogenic headache (CGH), or migraine. Design. A systematic review and meta-analysis. Methods. Eight databases were searched on September 15, 2023, including PubMed, Scopus, Web of Science, CINAHL, Cochrane Library, Embase, CNKI, and Wanfang Database. The risk of bias was evaluated utilizing the Cochrane Risk of Bias 2 (RoB 2) tool. Results. Pooled results showed that MFR intervention significantly reduces pain intensity [SMD = −2.01, 95% CI (−2.98, −1.03), I2 = 90%, P<0.001] and improves disability [SMD = −1.3, 95% CI (−1.82, −0.79), I2 = 74%, P<0.001]. Subgroup analysis based on the type of headache revealed significant reductions in pain intensity for CGH [SMD = −2.01, 95% CI (−2.73, −1.29), I2 = 63%, P<0.001], TTH [SMD = −0.86, 95% CI (−1.52, −0.20), I2 = 50%, P=0.01] and migraine [SMD = −6.52, 95% CI (−8.15, −4.89), P<0.001] and in disability for CGH [SMD = −1.45, 95% CI (−2.07, −0.83), I2 = 0%, P<0.001]; TTH [SMD = −0.98, 95% CI (−1.32, −0.65), I2 = 0%, P<0.001] but not migraine [SMD = −2.44, 95% CI (−6.04, 1.16), I2 = 97%, P=0.18]. Conclusion. The meta-analysis results indicate that MFR intervention can significantly alleviate pain and disability in TTH and CGH. For migraine, however, the results were inconsistent, and there was only moderate quality evidence of disability improvement for TTH and CGH. In contrast, the quality of other evidence was low or very low.
目的评估肌筋膜松解(MFR)技术对紧张型头痛(TTH)、颈源性头痛(CGH)或偏头痛患者的头痛疼痛强度和相关残疾的有效性。设计。系统回顾和荟萃分析。方法。于 2023 年 9 月 15 日检索了 8 个数据库,包括 PubMed、Scopus、Web of Science、CINAHL、Cochrane Library、Embase、CNKI 和万方数据库。利用 Cochrane Risk of Bias 2(RoB 2)工具评估了偏倚风险。结果显示汇总结果显示,MFR 干预能显著降低疼痛强度[SMD = -2.01,95% CI (-2.98, -1.03), I2 = 90%, P<0.001]并改善残疾状况[SMD = -1.3, 95% CI (-1.82, -0.79),I2 = 74%, P<0.001]。基于头痛类型的亚组分析显示,CGH [SMD = -2.01,95% CI (-2.73,-1.29),I2 = 63%,P<0.001]、TTH [SMD = -0.86,95% CI (-1.52,-0.20),I2 = 50%, P=0.01] 和偏头痛 [SMD = -6.52,95% CI (-8.15,-4.89),P<0.001],以及CGH[SMD =-1.45,95% CI (-2.07,-0.83),I2 = 0%,P<0.001];TTH[SMD = -0.98,95% CI (-1.32,-0.65),I2 = 0%,P<0.001],但偏头痛没有[SMD = -2.44,95% CI (-6.04,1.16),I2 = 97%,P=0.18]。结论荟萃分析结果表明,MFR干预能显著减轻TTH和CGH的疼痛和残疾。然而,偏头痛的研究结果并不一致,仅有中等质量的证据表明TTH和CGH的残疾情况有所改善。相比之下,其他证据的质量较低或很低。
{"title":"Myofascial Release for the Treatment of Tension-Type, Cervicogenic Headache or Migraine: A Systematic Review and Meta-Analysis","authors":"Zhoupeng Lu, Hui Zou, Peng Zhao, Jialin Wang, Ruirui Wang","doi":"10.1155/2024/2042069","DOIUrl":"https://doi.org/10.1155/2024/2042069","url":null,"abstract":"Objective. To assess the effectiveness of myofascial release (MFR) techniques on the intensity of headache pain and associated disability in patients with tension-type headache (TTH), cervicogenic headache (CGH), or migraine. Design. A systematic review and meta-analysis. Methods. Eight databases were searched on September 15, 2023, including PubMed, Scopus, Web of Science, CINAHL, Cochrane Library, Embase, CNKI, and Wanfang Database. The risk of bias was evaluated utilizing the Cochrane Risk of Bias 2 (RoB 2) tool. Results. Pooled results showed that MFR intervention significantly reduces pain intensity [SMD = −2.01, 95% CI (−2.98, −1.03), I2 = 90%, P<0.001] and improves disability [SMD = −1.3, 95% CI (−1.82, −0.79), I2 = 74%, P<0.001]. Subgroup analysis based on the type of headache revealed significant reductions in pain intensity for CGH [SMD = −2.01, 95% CI (−2.73, −1.29), I2 = 63%, P<0.001], TTH [SMD = −0.86, 95% CI (−1.52, −0.20), I2 = 50%, P=0.01] and migraine [SMD = −6.52, 95% CI (−8.15, −4.89), P<0.001] and in disability for CGH [SMD = −1.45, 95% CI (−2.07, −0.83), I2 = 0%, P<0.001]; TTH [SMD = −0.98, 95% CI (−1.32, −0.65), I2 = 0%, P<0.001] but not migraine [SMD = −2.44, 95% CI (−6.04, 1.16), I2 = 97%, P=0.18]. Conclusion. The meta-analysis results indicate that MFR intervention can significantly alleviate pain and disability in TTH and CGH. For migraine, however, the results were inconsistent, and there was only moderate quality evidence of disability improvement for TTH and CGH. In contrast, the quality of other evidence was low or very low.","PeriodicalId":501829,"journal":{"name":"Pain Research and Management","volume":"18 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140359305","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Interpectoral and Pectoserratus Plane Block vs. Local Anesthetic Infiltration for Partial Mastectomy: A Prospective Randomized Trial 乳房部分切除术中的胸骨间和胸肌平面阻滞与局部麻醉浸润:前瞻性随机试验
Pub Date : 2024-03-20 DOI: 10.1155/2024/9989997
Patryk Eisler, Stephan Zimmermann, Ragnar Henningsson
Background. Patients undergoing breast surgery are at risk of severe postoperative pain. Several opioid-sparing strategies exist to alleviate this condition. Regional anesthesia has long been a part of perioperative pain management for these patients. Aim. This randomized study examined the benefits of interpectoral and pectoserratus plane block (IPP/PSP), also known as pectoralis nerve plain block, compared with advanced local anesthetic infiltration. Methods. We analyzed 57 patients undergoing partial mastectomy with sentinel node dissection. They received either an ultrasound-guided IPP/PSP block performed preoperatively by an anesthetist or local anesthetic infiltration performed by the surgeon before and during the surgery. Results. Pain measured with the numerical rating scale (NRS) indicated no statistically significant difference between the groups (IPP/PSP 1.67 vs. infiltration 1.97; value 0.578). Intraoperative use of fentanyl was significantly lower in the IPP/PSP group (0.18 mg vs 0.21 mg; value 0.041). There was no statistically significant difference in the length of stay in the PACU (166 min vs 175 min; value 0.51). There were no differences in reported postoperative nausea and vomiting (PONV) between the groups. The difference in postoperative use of oxycodone in the PACU ( value 0.7) and the use of oxycodone within 24 hours postoperatively ( value 0.87) was not statistically significant. Conclusions. Our study showed decreased intraoperative o
背景。接受乳腺手术的患者有可能出现严重的术后疼痛。有几种阿片类药物节省策略可以缓解这种情况。区域麻醉长期以来一直是这些患者围手术期疼痛治疗的一部分。研究目的这项随机研究考察了胸肌间和栉状肌平面阻滞(IPP/PSP)(也称胸神经平块)与高级局麻药浸润相比的益处。方法。我们分析了 57 名接受乳房部分切除术和前哨节点切除术的患者。他们在术前接受了由麻醉师在超声引导下进行的 IPP/PSP 阻滞,或由外科医生在手术前和手术中进行的局麻药浸润。结果用数字评分量表(NRS)测量的疼痛感显示,两组之间没有显著的统计学差异(IPP/PSP 1.67 vs. 浸润 1.97;数值 0.578)。IPP/PSP 组的术中芬太尼用量明显较低(0.18 毫克 vs 0.21 毫克;数值 0.041)。在 PACU 的住院时间差异无统计学意义(166 分钟 vs 175 分钟;数值 0.51)。两组在术后恶心和呕吐(PONV)方面没有差异。术后在 PACU 使用羟考酮(值 0.7)和术后 24 小时内使用羟考酮(值 0.87)的差异无统计学意义。结论。我们的研究表明,IPP/PSP 组术中阿片类药物用量减少,术后 24 小时内疼痛评分无差异。两组术后疼痛评分均较低。该试验已在 NCT04824599 上注册。
{"title":"Interpectoral and Pectoserratus Plane Block vs. Local Anesthetic Infiltration for Partial Mastectomy: A Prospective Randomized Trial","authors":"Patryk Eisler, Stephan Zimmermann, Ragnar Henningsson","doi":"10.1155/2024/9989997","DOIUrl":"https://doi.org/10.1155/2024/9989997","url":null,"abstract":"<i>Background</i>. Patients undergoing breast surgery are at risk of severe postoperative pain. Several opioid-sparing strategies exist to alleviate this condition. Regional anesthesia has long been a part of perioperative pain management for these patients. <i>Aim</i>. This randomized study examined the benefits of interpectoral and pectoserratus plane block (IPP/PSP), also known as pectoralis nerve plain block, compared with advanced local anesthetic infiltration. <i>Methods</i>. We analyzed 57 patients undergoing partial mastectomy with sentinel node dissection. They received either an ultrasound-guided IPP/PSP block performed preoperatively by an anesthetist or local anesthetic infiltration performed by the surgeon before and during the surgery. <i>Results</i>. Pain measured with the numerical rating scale (NRS) indicated no statistically significant difference between the groups (IPP/PSP 1.67 vs. infiltration 1.97; <svg height=\"10.2124pt\" style=\"vertical-align:-3.42943pt\" version=\"1.1\" viewbox=\"-0.0498162 -6.78297 7.83752 10.2124\" width=\"7.83752pt\" xmlns=\"http://www.w3.org/2000/svg\" xmlns:xlink=\"http://www.w3.org/1999/xlink\"><g transform=\"matrix(.013,0,0,-0.013,0,0)\"></path></g></svg> value 0.578). Intraoperative use of fentanyl was significantly lower in the IPP/PSP group (0.18 mg vs 0.21 mg; <svg height=\"10.2124pt\" style=\"vertical-align:-3.42943pt\" version=\"1.1\" viewbox=\"-0.0498162 -6.78297 7.83752 10.2124\" width=\"7.83752pt\" xmlns=\"http://www.w3.org/2000/svg\" xmlns:xlink=\"http://www.w3.org/1999/xlink\"><g transform=\"matrix(.013,0,0,-0.013,0,0)\"><use xlink:href=\"#g113-113\"></use></g></svg> value 0.041). There was no statistically significant difference in the length of stay in the PACU (166 min vs 175 min; <svg height=\"10.2124pt\" style=\"vertical-align:-3.42943pt\" version=\"1.1\" viewbox=\"-0.0498162 -6.78297 7.83752 10.2124\" width=\"7.83752pt\" xmlns=\"http://www.w3.org/2000/svg\" xmlns:xlink=\"http://www.w3.org/1999/xlink\"><g transform=\"matrix(.013,0,0,-0.013,0,0)\"><use xlink:href=\"#g113-113\"></use></g></svg> value 0.51). There were no differences in reported postoperative nausea and vomiting (PONV) between the groups. The difference in postoperative use of oxycodone in the PACU (<svg height=\"10.2124pt\" style=\"vertical-align:-3.42943pt\" version=\"1.1\" viewbox=\"-0.0498162 -6.78297 7.83752 10.2124\" width=\"7.83752pt\" xmlns=\"http://www.w3.org/2000/svg\" xmlns:xlink=\"http://www.w3.org/1999/xlink\"><g transform=\"matrix(.013,0,0,-0.013,0,0)\"><use xlink:href=\"#g113-113\"></use></g></svg> value 0.7) and the use of oxycodone within 24 hours postoperatively (<svg height=\"10.2124pt\" style=\"vertical-align:-3.42943pt\" version=\"1.1\" viewbox=\"-0.0498162 -6.78297 7.83752 10.2124\" width=\"7.83752pt\" xmlns=\"http://www.w3.org/2000/svg\" xmlns:xlink=\"http://www.w3.org/1999/xlink\"><g transform=\"matrix(.013,0,0,-0.013,0,0)\"><use xlink:href=\"#g113-113\"></use></g></svg> value 0.87) was not statistically significant. <i>Conclusions</i>. Our study showed decreased intraoperative o","PeriodicalId":501829,"journal":{"name":"Pain Research and Management","volume":"5 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140170831","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Relationships between the Spinal Dural Pulsations and the Short-Term Efficacy of Lumbar Epidural Steroid Injection 脊髓硬膜搏动与腰椎硬膜外类固醇注射短期疗效的关系
Pub Date : 2024-03-18 DOI: 10.1155/2024/1824269
Chan Hong Park, Sang Ho Lee
Background. Lumbar spinal stenosis (LSS) causes low back pain, leg pain, numbness in the leg, and neurogenic intermittent claudication. Epidural steroid injection (ESI) has been used for treating spinal stenosis symptoms. We hypothesized that dural pulsation was variable for lumbar spinal stenosis. In cases of the presence of dural pulsation, the pain relief after the ESI was better than in the absence of dural pulsation. This study aimed at investigating the relationships between the presence or absence of spinal dural pulsations and the efficacy of ESI. Methods. A total of 71 patients were enrolled in this prospective study. Prior to the ESI, the dural pulsation was measured using a 5-1 MHz array ultrasound transducer. The visual analogue scale (VAS) score was measured pre-ESI and 2 weeks post-ESI and 4 weeks post-ESI. At 4 weeks post-ESI, dural pulsation was rechecked. Results. The VAS scores improved after the ESI procedure regardless of the presence or absence of dural pulsation. There was a correlation between the pulsation of the dura and post-ESI VAS scores. However, VAS was not significantly different for different grades of stenosis. Conclusion. The ESI was effective in patients with spinal stenosis in short-term follow-up. Dural pulsation of the spinal cord was a positive predictive factor for the ESI effect, but the grade of spinal stenosis severity had no effect on the effectiveness of ESI.
背景。腰椎管狭窄症(LSS)会导致腰痛、腿痛、腿部麻木和神经源性间歇性跛行。硬膜外类固醇注射(ESI)已被用于治疗椎管狭窄症状。我们假设硬脊膜搏动是腰椎管狭窄症的可变因素。在存在硬脊膜搏动的情况下,ESI 后的疼痛缓解效果优于无硬脊膜搏动的情况。本研究旨在探讨是否存在脊髓硬脊膜搏动与 ESI 疗效之间的关系。研究方法共有 71 名患者参与了这项前瞻性研究。在进行 ESI 之前,使用 5-1 MHz 阵列超声换能器测量硬脊膜搏动。ESI前、ESI后2周和4周测量视觉模拟量表(VAS)评分。硬膜外麻醉后 4 周,再次检查硬膜搏动。结果。无论是否存在硬脊膜搏动,ESI术后VAS评分均有所改善。硬脊膜搏动与ESI术后VAS评分之间存在相关性。不过,不同狭窄等级的 VAS 没有明显差异。结论。在短期随访中,ESI对椎管狭窄患者有效。脊髓硬膜搏动是预测 ESI 效果的一个积极因素,但脊柱狭窄严重程度的等级对 ESI 的效果没有影响。
{"title":"Relationships between the Spinal Dural Pulsations and the Short-Term Efficacy of Lumbar Epidural Steroid Injection","authors":"Chan Hong Park, Sang Ho Lee","doi":"10.1155/2024/1824269","DOIUrl":"https://doi.org/10.1155/2024/1824269","url":null,"abstract":"<i>Background</i>. Lumbar spinal stenosis (LSS) causes low back pain, leg pain, numbness in the leg, and neurogenic intermittent claudication. Epidural steroid injection (ESI) has been used for treating spinal stenosis symptoms. We hypothesized that dural pulsation was variable for lumbar spinal stenosis. In cases of the presence of dural pulsation, the pain relief after the ESI was better than in the absence of dural pulsation. This study aimed at investigating the relationships between the presence or absence of spinal dural pulsations and the efficacy of ESI. <i>Methods</i>. A total of 71 patients were enrolled in this prospective study. Prior to the ESI, the dural pulsation was measured using a 5-1 MHz array ultrasound transducer. The visual analogue scale (VAS) score was measured pre-ESI and 2 weeks post-ESI and 4 weeks post-ESI. At 4 weeks post-ESI, dural pulsation was rechecked. <i>Results</i>. The VAS scores improved after the ESI procedure regardless of the presence or absence of dural pulsation. There was a correlation between the pulsation of the dura and post-ESI VAS scores. However, VAS was not significantly different for different grades of stenosis. <i>Conclusion</i>. The ESI was effective in patients with spinal stenosis in short-term follow-up. Dural pulsation of the spinal cord was a positive predictive factor for the ESI effect, but the grade of spinal stenosis severity had no effect on the effectiveness of ESI.","PeriodicalId":501829,"journal":{"name":"Pain Research and Management","volume":"67 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140150690","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
NGF Signaling Exacerbates KOA Peripheral Hyperalgesia via the Increased TRPV1-Labeled Synovial Sensory Innervation in KOA Rats NGF 信号通过增加 TRPV1 标记的 KOA 大鼠滑膜感觉神经传导加剧 KOA 周围痛觉减退
Pub Date : 2024-02-19 DOI: 10.1155/2024/1552594
Zixiu Liu, Mingchao Li, Li Zhang, Xiaoqing Shi, Taiyang Liao, Lishi Jie, Likai Yu, Peimin Wang
Objectives. Knee osteoarthritis (KOA) pain is caused by nociceptors, which are actually sensory nerve fiber endings that can detect stimuli to produce and transmit pain signals, and high levels of NGF in synovial tissue led to peripheral hyperalgesia in KOA. The purpose of this study is to investigate how sensory nerve fibers respond to the NGF/TrKA signal pathway and mediate the peripheral hyperalgesia in KOA rats. Methods. Forty SD male rats were randomly divided into 4 groups: normal, KOA, KOA + NGF, and KOA + siRNA TrKA. KOA model rats were induced by anterior cruciate ligament transection (ACLT). Mechanical and cold withdrawal thresholds (MWT and CWT) were measured 4 times in each group. The synovial tissues were harvested on day 28, and the expressions of NGF, TrKA, TRPV1, IL-1β, and PGP9.5 were determined using western blot, qPCR, and immunofluorescence staining. The primary rat fibroblast-like synoviocytes (FLSs) and DRG cells were divided into 4 groups as in vivo. The expressions of NGF, TrKA, TRPV1, and CGRP in vitro were determined using western blot and qPCR. Results. KOA and intra-articular injection with NGF protein increased both mRNA and protein levels, not only TRPV1, PGP 9.5, and IL-1β in the synovial tissue, but also TRPV1, PGP 9.5, and S100 in the DRG tissue, while above changes were partly reversed after siRNA TrKA intervention. Besides, siRNA TrKA could improve peripheral hyperalgesia and decreased the TRPV1 positive nerve fiber innervation in synovial tissue. The results in vitro were consistent with those in vivo. Conclusion. This study showed the activation of the NGF/TrKA signaling pathway in KOA promoted the release of pain mediators, increased the innervation of sensory nerve fibers in the synovium, and worsened peripheral hyperalgesia. It also showed increased TRPV1 positive sensory innervation in KOA was mediated by NGF/TrKA signaling and exacerbated peripheral hyperalgesia.
目的。膝关节骨关节炎(KOA)疼痛是由痛觉感受器引起的,痛觉感受器实际上是感觉神经纤维末梢,可以检测刺激产生和传递疼痛信号,滑膜组织中高水平的 NGF 会导致 KOA 周围痛觉减退。本研究的目的是探讨感觉神经纤维如何响应 NGF/TrKA 信号通路并介导 KOA 大鼠的外周痛觉减退。研究方法将 40 只 SD 雄性大鼠随机分为 4 组:正常组、KOA 组、KOA + NGF 组和 KOA + siRNA TrKA 组。KOA 模型大鼠由前十字韧带横断(ACLT)诱导。每组测量 4 次机械阈值和冷退缩阈值(MWT 和 CWT)。第 28 天采集滑膜组织,采用 Western 印迹、qPCR 和免疫荧光染色法检测 NGF、TrKA、TRPV1、IL-1β 和 PGP9.5 的表达。将原代大鼠成纤维细胞样滑膜细胞(FLSs)和DRG细胞按体内方法分为4组。采用 Western 印迹和 qPCR 方法测定 NGF、TrKA、TRPV1 和 CGRP 在体外的表达。结果KOA 和关节内注射 NGF 蛋白不仅增加了滑膜组织中 TRPV1、PGP 9.5 和 IL-1β 的 mRNA 和蛋白水平,而且增加了 DRG 组织中 TRPV1、PGP 9.5 和 S100 的 mRNA 和蛋白水平。此外,siRNA TrKA还能改善外周痛觉减退,减少滑膜组织中TRPV1阳性神经纤维的支配。体外实验结果与体内实验结果一致。结论本研究表明,KOA 中 NGF/TrKA 信号通路的激活促进了疼痛介质的释放,增加了滑膜中感觉神经纤维的支配,加重了外周痛觉减退。研究还显示,KOA中TRPV1阳性感觉神经支配的增加是由NGF/TrKA信号传导介导的,并加剧了外周痛觉减退。
{"title":"NGF Signaling Exacerbates KOA Peripheral Hyperalgesia via the Increased TRPV1-Labeled Synovial Sensory Innervation in KOA Rats","authors":"Zixiu Liu, Mingchao Li, Li Zhang, Xiaoqing Shi, Taiyang Liao, Lishi Jie, Likai Yu, Peimin Wang","doi":"10.1155/2024/1552594","DOIUrl":"https://doi.org/10.1155/2024/1552594","url":null,"abstract":"<i>Objectives</i>. Knee osteoarthritis (KOA) pain is caused by nociceptors, which are actually sensory nerve fiber endings that can detect stimuli to produce and transmit pain signals, and high levels of NGF in synovial tissue led to peripheral hyperalgesia in KOA. The purpose of this study is to investigate how sensory nerve fibers respond to the NGF/TrKA signal pathway and mediate the peripheral hyperalgesia in KOA rats. <i>Methods</i>. Forty SD male rats were randomly divided into 4 groups: normal, KOA, KOA + NGF, and KOA + siRNA TrKA. KOA model rats were induced by anterior cruciate ligament transection (ACLT). Mechanical and cold withdrawal thresholds (MWT and CWT) were measured 4 times in each group. The synovial tissues were harvested on day 28, and the expressions of NGF, TrKA, TRPV1, IL-1<i>β</i>, and PGP9.5 were determined using western blot, qPCR, and immunofluorescence staining. The primary rat fibroblast-like synoviocytes (FLSs) and DRG cells were divided into 4 groups as in vivo. The expressions of NGF, TrKA, TRPV1, and CGRP in vitro were determined using western blot and qPCR. <i>Results</i>. KOA and intra-articular injection with NGF protein increased both mRNA and protein levels, not only TRPV1, PGP 9.5, and IL-1<i>β</i> in the synovial tissue, but also TRPV1, PGP 9.5, and S100 in the DRG tissue, while above changes were partly reversed after siRNA TrKA intervention. Besides, siRNA TrKA could improve peripheral hyperalgesia and decreased the TRPV1 positive nerve fiber innervation in synovial tissue. The results in vitro were consistent with those in vivo. <i>Conclusion</i>. This study showed the activation of the NGF/TrKA signaling pathway in KOA promoted the release of pain mediators, increased the innervation of sensory nerve fibers in the synovium, and worsened peripheral hyperalgesia. It also showed increased TRPV1 positive sensory innervation in KOA was mediated by NGF/TrKA signaling and exacerbated peripheral hyperalgesia.","PeriodicalId":501829,"journal":{"name":"Pain Research and Management","volume":"9 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139918908","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Neuropathic Pain Medication and Antidepressant Use after Disability Pension in Patients with Spinal Cord Stimulation for Persistent Spinal Pain Syndrome 脊髓刺激治疗顽固性脊髓疼痛综合征患者残疾抚恤金发放后的神经痛药物和抗抑郁药使用情况
Pub Date : 2024-01-31 DOI: 10.1155/2024/4953758
Hanna Kaijankoski, Mette Nissen, Tiina-Mari Ikäheimo, Mikael von und zu Fraunberg, Olavi Airaksinen, Jukka Huttunen
Background. Treatment of persistent spinal pain syndrome (PSPS) is challenging. Chronic pain associated with PSPS can lead to an impaired ability to work. Objective. To obtain information on whether receiving a disability pension (DP) affects pain and pain treatments in retiring working-age PSPS patients. Neuropathic pain medication and antidepressant use were considered as an indicator of neuropathic pain. Methods. The study group comprised 129 consecutive PSPS patients with spinal cord stimulation (SCS) devices implanted at Kuopio University Hospital Neurosurgery between January 1, 1996, and December 31, 2014. Purchase data of gabapentinoids, tricyclic antidepressants, and serotonin-norepinephrine reuptake inhibitors from January 1995 to March 2016, as well as the data on working ability, were retrieved from national registries. Results. The data showed that 28 of 129 (21.7%) SCS permanent patients had a DP, and 27 had a sufficient follow-up time (two years before and one year after DP). Most patients (61%) used neuropathic pain medications during the follow-up, while 44% used antidepressants. Most patients (70%, n = 19) retired because of dorsopathies. The dose of gabapentinoids started to increase before the DP; after the DP, the doses started to increase again after the decrease but remained at a lower level. Conclusions. Neuropathic pain medication and antidepressant use suggest that pain continues after the DP—that is, pensioners continue to experience inconvenient chronic pain. Resources for patient care are therefore needed after the DP. However, the DP reduces the dose increase of gabapentinoids; the dose is higher immediately before retirement than at the end of the follow-up.
背景。持续性脊柱疼痛综合征(PSPS)的治疗具有挑战性。与持续性脊柱疼痛综合征相关的慢性疼痛可导致工作能力受损。目的。了解领取伤残抚恤金(DP)是否会影响即将退休的工作年龄 PSPS 患者的疼痛和疼痛治疗。神经病理性疼痛药物和抗抑郁药的使用被视为神经病理性疼痛的指标。研究方法研究组包括1996年1月1日至2014年12月31日期间在库奥皮奥大学医院神经外科植入脊髓刺激(SCS)装置的129名连续PSPS患者。1995年1月至2016年3月期间加巴喷丁类、三环类抗抑郁药和5-羟色胺-去甲肾上腺素再摄取抑制剂的购买数据以及工作能力数据均来自国家登记处。结果显示数据显示,129名SCS永久患者中有28名(21.7%)曾接受过DP治疗,27名患者有足够的随访时间(DP治疗前两年和DP治疗后一年)。大多数患者(61%)在随访期间使用了神经痛药物,44%使用了抗抑郁药物。大多数患者(70%,n = 19)因背痛而退休。加巴喷丁类药物的剂量在DP前开始增加;DP后,剂量在减少后又开始增加,但仍保持在较低水平。结论神经病理性疼痛药物和抗抑郁药物的使用表明,疼痛在退休后仍在继续,也就是说,退休人员仍在经历不便的慢性疼痛。因此,在养老金发放后,还需要为患者护理提供资源。然而,养老金领取计划减少了加巴喷丁类药物剂量的增加;退休前的剂量高于随访结束时的剂量。
{"title":"Neuropathic Pain Medication and Antidepressant Use after Disability Pension in Patients with Spinal Cord Stimulation for Persistent Spinal Pain Syndrome","authors":"Hanna Kaijankoski, Mette Nissen, Tiina-Mari Ikäheimo, Mikael von und zu Fraunberg, Olavi Airaksinen, Jukka Huttunen","doi":"10.1155/2024/4953758","DOIUrl":"https://doi.org/10.1155/2024/4953758","url":null,"abstract":"<i>Background</i>. Treatment of persistent spinal pain syndrome (PSPS) is challenging. Chronic pain associated with PSPS can lead to an impaired ability to work. <i>Objective</i>. To obtain information on whether receiving a disability pension (DP) affects pain and pain treatments in retiring working-age PSPS patients. Neuropathic pain medication and antidepressant use were considered as an indicator of neuropathic pain. <i>Methods</i>. The study group comprised 129 consecutive PSPS patients with spinal cord stimulation (SCS) devices implanted at Kuopio University Hospital Neurosurgery between January 1, 1996, and December 31, 2014. Purchase data of gabapentinoids, tricyclic antidepressants, and serotonin-norepinephrine reuptake inhibitors from January 1995 to March 2016, as well as the data on working ability, were retrieved from national registries. <i>Results</i>. The data showed that 28 of 129 (21.7%) SCS permanent patients had a DP, and 27 had a sufficient follow-up time (two years before and one year after DP). Most patients (61%) used neuropathic pain medications during the follow-up, while 44% used antidepressants. Most patients (70%, <i>n</i> = 19) retired because of dorsopathies. The dose of gabapentinoids started to increase before the DP; after the DP, the doses started to increase again after the decrease but remained at a lower level. <i>Conclusions</i>. Neuropathic pain medication and antidepressant use suggest that pain continues after the DP—that is, pensioners continue to experience inconvenient chronic pain. Resources for patient care are therefore needed after the DP. However, the DP reduces the dose increase of gabapentinoids; the dose is higher immediately before retirement than at the end of the follow-up.","PeriodicalId":501829,"journal":{"name":"Pain Research and Management","volume":"43 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139648690","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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Pain Research and Management
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