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Rev. colomb. anestesiol ; 49(2): e501, Apr.-June 2021. graf
Article in English | LILACS, COLNAL | ID: biblio-1251503


Abstract Introduction Neuropathic pain is present in up to 40 % of all cancer patients. A considerable number of patients fail to achieve enough pain relief with conventional treatment, which is why therapeutic alternatives such as spinal cord stimulation should be considered. Case description and results This is the case of a female patient with chronic neuropathic pain secondary to a partial femoral nerve injury sustained during resection and lymph node dissection surgery with curative intent for a large stage II cell squamous cell carcinoma T2N0M0, localized in the right popliteal fossa. The patient presented with difficult to manage chronic neuropathic pain, despite receiving multiple oral analgesics and nerve blocks. A medullary neurostimulator was implanted that relieved the patient's pain intensity in up to 80%, in addition to improved function and quality of life. Conclusions Spinal cord stimulation is considered an effective neuromodulatory intervention which has shown satisfactory results in the treatment of various types of refractory chronic pain in cancer patients, including neuropathic pain.

Resumen Introducción El dolor neuropático está presente hasta en el 40 % de los pacientes con cáncer. Un número considerable de pacientes no logran un alivio suficiente del dolor con el tratamiento convencional, por lo cual deben considerarse alternativas terapéuticas como la estimulación de la médula espinal. Descripción del caso y resultados Caso de una paciente con dolor neuropático crónico secundario a lesión parcial de nervio femoral durante cirugía de resección y vaciamiento ganglionar con objetivos curativos de carcinoma escamocelular de célula grande T2N0M0 estadio II, localizado en la fosa poplítea derecha, quien cursó con dolor neuropático crónico de difícil manejo a pesar de recibir múltiples analgésicos orales y bloqueos nerviosos. Se implantó un neuroestimulador medular con lo cual se logró un alivio hasta del 80 % en intensidad de dolor de la paciente, además de una mejoría de su funcionalidad y calidad de vida. Conclusiones La estimulación de la médula espinal se considera una intervención neuromoduladora eficaz, que ha demostrado resultados satisfactorios para tratar diversas formas de dolor crónico refractario en los pacientes con cáncer, incluido el dolor neuropático.

Humans , Female , Middle Aged , Carcinoma, Squamous Cell , Chronic Pain , Pain Management , Spinal Cord Stimulation , Lymph Node Excision , Neoplasms , Quality of Life , Therapeutics , Cells , Femoral Nerve , Analgesics , Nerve Block , Neuralgia
Acta Physiologica Sinica ; (6): 223-232, 2021.
Article in English | WPRIM | ID: wpr-878251


The present study was aimed to investigate the role of GluN2B-BDNF pathway in the cerebrospinal fluid-contacting nucleus (CSF-CN) in neuropathic pain. Intra-lateral ventricle injection of cholera toxin subunit B conjugated with horseradish peroxidase (CBHRP) was used to label the CSF-CN. Double-labeled immunofluorescent staining and Western blot were used to observe the expression of GluN2B and BDNF in the CSF-CN. Chronic constriction injury of sciatic nerve (CCI) rat model was used to duplicate the neuropathic pain. Pain behavior was scored to determine the analgesic effects of GluN2B antagonist Ro 25-6981 and BDNF neutralizing antibody on CCI rats. GluN2B and BDNF were expressed in the CSF-CN and their expression was up-regulated in CCI rats. Intra-lateral ventricle injection of GluN2B antagonist Ro 25-6981 or BDNF neutralizing antibody notably alleviated thermal hyperalgesia and mechanical allodynia in CCI rats. Moreover, the increased expression of BDNF protein in CCI rats was reversed by intra-lateral ventricle injection of Ro 25-6981. These results suggest that GluN2B and BDNF are expressed in the CSF-CN and alteration of GluN2B-BDNF pathway in the CSF-CN is involved in the modulation of the peripheral neuropathic pain.

Animals , Brain-Derived Neurotrophic Factor , Hyperalgesia , Neuralgia , Rats , Rats, Sprague-Dawley , Sciatic Nerve
Braz. j. med. biol. res ; 54(10): e11207, 2021. tab, graf
Article in English | LILACS | ID: biblio-1285643


Reactive oxygen species (ROS) are involved in neuropathic pain, a complicated condition after nerve tissue lesion. Vitamin D appears to improve symptoms of pain and exhibits antioxidant properties. We investigated the effects of oral administration of vitamin D3, the active form of vitamin D, on nociception, the sciatic functional index (SFI), and spinal cord pro-oxidant and antioxidant markers in rats with chronic constriction injury (CCI) of the sciatic nerve, a model of neuropathic pain. Vitamin D3 (500 IU/kg per day) attenuated the CCI-induced decrease in mechanical withdrawal threshold and thermal withdrawal latency (indicators of antinociception) and SFI. The vitamin prevented increased lipid hydroperoxide levels in injured sciatic nerve without change to total antioxidant capacity (TAC). Vitamin D3 prevented increased lipid hydroperoxide, superoxide anion generation (SAG), and hydrogen peroxide (H2O2) levels in the spinal cord, which were found in rats without treatment at 7 and 28 days post-CCI. A significant negative correlation was found between mechanical threshold and SAG and between mechanical threshold and H2O2 at day 7. Vitamin D3 also prevented decreased spinal cord total thiols content. There was an increase in TAC in the spinal cord of vitamin-treated CCI rats, compared to CCI rats without treatment only at 28 days. No significant changes were found in body weight and blood parameters of hepatic and renal function. These findings demonstrated, for first time, that vitamin D modulated pro-oxidant and antioxidant markers in the spinal cord. Since antinociception occurred in parallel with oxidative changes in the spinal cord, the oxidative changes may have contributed to vitamin D-induced antinociception.

Animals , Rats , Neuralgia/drug therapy , Antioxidants , Sciatic Nerve , Spinal Cord , Vitamin D , Vitamins , Reactive Oxygen Species , Rats, Wistar , Nociception , Hydrogen Peroxide , Hyperalgesia/drug therapy
Arq. neuropsiquiatr ; 78(11): 741-752, Nov. 2020. tab, graf
Article in English | LILACS | ID: biblio-1142359


ABSTRACT Background: Central neuropathic pain (CNP) is often refractory to available therapeutic strategies and there are few evidence-based treatment options. Many patients with neuropathic pain are not diagnosed or treated properly. Thus, consensus-based recommendations, adapted to the available drugs in the country, are necessary to guide clinical decisions. Objective: To develop recommendations for the treatment of CNP in Brazil. Methods: Systematic review, meta-analysis, and specialists opinions considering efficacy, adverse events profile, cost, and drug availability in public health. Results: Forty-four studies on CNP treatment were found, 20 were included in the qualitative analysis, and 15 in the quantitative analysis. Medications were classified as first-, second-, and third-line treatment based on systematic review, meta-analysis, and expert opinion. As first-line treatment, gabapentin, duloxetine, and tricyclic antidepressants were included. As second-line, venlafaxine, pregabalin for CND secondary to spinal cord injury, lamotrigine for CNP after stroke, and, in association with first-line drugs, weak opioids, in particular tramadol. For refractory patients, strong opioids (methadone and oxycodone), cannabidiol/delta-9-tetrahydrocannabinol, were classified as third-line of treatment, in combination with first or second-line drugs and, for central nervous system (CNS) in multiple sclerosis, dronabinol. Conclusions: Studies that address the treatment of CNS are scarce and heterogeneous, and a significant part of the recommendations is based on experts opinions. The CNP approach must be individualized, taking into account the availability of medication, the profile of adverse effects, including addiction risk, and patients' comorbidities.

RESUMO Introdução: A dor neuropática central (DNC) é frequentemente refratária às estratégias terapêuticas disponíveis e há poucas opções de tratamento baseado em evidência. Muitos pacientes com dor neuropática não são diagnosticados ou tratados adequadamente. Desse modo, recomendações baseadas em consenso, adaptadas à disponibilidade de medicamentos no país, são necessárias para guiar decisões clínicas. Objetivo: Desenvolver recomendações para o tratamento da DNC no Brasil. Métodos: Revisão sistemática, metanálise e discussão dos resultados entre especialistas e pesquisadores da área, considerando eficácia, perfil de eventos adversos, custo e disponibilidade do fármaco na saúde pública. Resultados: Foram encontrados 44 estudos sobre tratamento da DNC, dos quais 20 foram incluídos na análise qualitativa e 15, na quantitativa. Classificaram-se as medicações em primeira, segunda e terceira linhas de tratamento, baseando-se em revisão sistemática, meta-análise e opinião de especialistas. Como primeira linha, foram incluídos gabapentina, duloxetina e antidepressivos tricíclicos. Como segunda, venlafaxina, pregabalina para DNC secundária à lesão medular, lamotrigina para DNC pós-acidente vascular cerebral e, em associação aos fármacos de primeira linha, opioides fracos, em particular tramadol. Para os pacientes refratários, opioides fortes (metadona e oxicodona) e canabidiol/delta-9-tetrahidrocanabinol foram classificados como terceira linha de tratamento, em associação com drogas de primeira ou segunda linha, e, para DNC na esclerose múltipla, dronabinol. Conclusões: Os estudos que abordam o tratamento da DNC são escassos e heterogêneos, e parte significativa das recomendações é baseada em opiniões de especialistas. A abordagem da DNC deve ser individualizada, levando em conta a disponibilidade de medicação, o perfil de efeitos adversos, incluindo risco de dependência e as comorbidades do paciente.

Humans , Neuralgia/drug therapy , Neurology , Brazil , Consensus , Analgesics, Opioid
Rev. argent. neurocir ; 34(3): 149-162, sept. 2020. ilus, graf, tab
Article in Spanish | LILACS, BINACIS | ID: biblio-1120864


Introducción: Introducción: La compresión percutánea con balón (CPB) es una de las técnicas estándar para el tratamiento de la neuralgia del trigémino. El objetivo de este estudio es evaluar la eficacia de la compresión percutánea con balón (CPB) del ganglio de Gasser y raíz trigeminal en el tratamiento de la neuralgia del trigémino (TN). Métodos: Se usó un estudio observacional analítico de cohorte prospectivo. Un total de 293 pacientes con neuralgia del trigémino fueron tratados con la CPB entre octubre de 2008 y octubre de 2019 en Lima, Perú. Los datos fueron obtenidos de los registros hospitalarios y entrevistas. La CPB se realizó bajo sedación con propofol y remifentanilo. Se administróoxígeno a través de cánula nasal y se monitorizó la frecuencia cardíaca y la presión arterial durante todo el procedimiento. Elprocedimiento se realizó usando fluoroscopia con arco en C para facilitar la introducción de la aguja 14 G hasta que se ingresaal agujero oval y la visualización del catéter Fogarty 4F inflado en el cavum de Meckel. En la posición correcta, generalmenteaparece claramente definido una forma de pera o de reloj de arena después de la inyección de 0.5-1 ml de material decontraste. Resultados: La edad media fue de 64.2 años (rango 27-90). Treinta y seis pacientes (12%) tuvieron otros procedimientosquirúrgicos previos. Doscientos sesenta y dos pacientes (89.4%) experimentaron un alivio inmediato de la neuralgia despuésdel procedimiento. Se obtuvo un balón con forma de pera en 162 casos (55.3%), reloj de arena 73 (24.9%) y oval 58 (19.8%). En 245 pacientes (83.6%) el balón se mantuvo inflado durante 60 - 90 segundos. Es crucial obtener una forma de pera o de reloj de arena porque este es probablemente el factor más importante para obtener un buen alivio del dolor y duradero. Todo el procedimiento dura unos 15 minutos. La hipoestesia hemifacial después del procedimiento fue moderada o severa en el 76.5% de los pacientes. A los tres meses, la mayoría de los pacientes tienen una recuperación significativa en la sensibilidad facial, que continúa recuperándose con el tiempo. Todos los pacientes tuvieron alguna dificultad transitoria para masticar en el lado afectado. Se observó recurrencia en 26 pacientes (9.2%) en un tiempo de seguimiento de 6 meses a 11 años (5.75 años). La forma más común de balón asociada con recurrencia fue la oval (65.4%).Conclusiones: La CPB es técnicamente simple, bien tolerada por los pacientes. La tasa de éxito de la operación es alta. Los pacientes con balón en forma de pera o de reloj de arena obtuvieron los mejores resultados.

Introduction: Percutaneous balloon compression (PBC) is one of the standards techniques for the treatment of trigeminal neuralgia.The objective of this study is to evaluate the efficacy of PBC of the Gasserian ganglion and trigeminal rootlets as treatment for trigeminal neuralgia (TN). Methods: A prospective cohort analytical observational study was used. A total of 293 patients with trigeminal neuralgia were treated with PBC between october 2008 and October 2019 in Lima, Perú. The data were obtained from hospital records and interviews. PBC was performed under sedation with propofol and remifentanil. Oxygen was administered through nasal cannula and the heart rate and blood pressure were monitored throughout the procedure. The procedure is carried out with C-arm fluoroscopy to facilitate the introduction of the 14 G needle until the foramen oval is entered and the visualization of the inflated catheter Fogarty 4F in the Meckel ́s cave. Once in the right position, a clearly defined pear shape or hourglass is seen after injection of 0.5 ­ 1 mL of contrast material. Results: The mean age was 64.2 years (range, 27-90). Thirty-six patients (12%) had other previous surgical procedures. Two hundred sixty-two patients (89.4%) experienced immediate relief from neuralgia following the procedure. A pear-shaped balloon was obtained in 162 cases (55.3%), hourglass 73 (24.9%) and oval 58 (19.8%). In 245 patients (83.6%) the balloon is kept inflated for 60­90 seconds. It is crucial to obtain a pear shape or hourglass because this probably is the most significant factor for obtaining good, long-lasting pain relief. The whole procedure takes 15 minutes. Following the procedure, hemifacial hypoesthesia was moderate or severe in 76.5% of patients. Most patients have a significant recovery in facial sensitivity at three months post-procedure and continue to improve over time. All patients faced some transient difficulty chewing in the affected side. Recurrence was observed in 26 patients (9.2%) during a follow-up time of 6 months to 11 years (5.75 years). The most common form of balloon associated with recurrence was oval (65.4%).Conclusions: PBC is a technically simple, well tolerated by patients. The operation success rate is high. Patients with pear or hourglass shape balloon obtained the best results.

Humans , Trigeminal Neuralgia , Therapeutics , Trigeminal Ganglion , Mastication , Neuralgia
Rev. argent. neurocir ; 34(3): 163-171, sept. 2020. ilus, graf, tab
Article in Spanish | LILACS, BINACIS | ID: biblio-1120874


Objetivos: Describir resultados de los últimos 11 años en el tratamiento de neuralgia del trigémino con termocoagulación por radiofrecuencia, analizar variables relacionadas a complicaciones y resultados. Material y Métodos: Estudio retrospectivo, descriptivo, longitudinal, comparativo y analítico. Se analizaron los resultados de los últimos 11 años de nuestro servicio evaluando las temperaturas de las lesiones armando dos grupos, de 65°C-70°C y 71°C-75°C para analizar su relación con resultados y complicaciones. Resultados: Se trataron 59 pacientes en los cuales se realizaron 74 procedimientos, la edad media fue 59.22 años (±13,45). Se observó recidiva en 23 procedimientos con una tasa global de 31%. El tiempo medio de recidiva fue de 28,19 meses (±26,21). El tiempo medio de seguimiento fue de 33,10 meses (±33,49). El tiempo medio de evolución del dolor, previo al primer procedimiento, fue de 5,35 años (±4,37). Analizando los grupos se observó que no existía relación significativamente estadística (p = 0,74) entre el grupo de pacientes de 65ºC-70ºC y el grupo de 71ºC-75ºC y recidiva. No se observó relación estadísticamente significativa entre el grupo de 65ºC-70ºC y el grupo de 71ºC-75ºC y tiempo de recidiva (p=0,12). Se observó más pacientes con hipoestesia inmediata en el grupo de pacientes de 65ºC-70ºC, sin significación estadística (p=0,47). Conclusión: La termocoagulación por radiofrecuencia de ganglio de Gasser es un procedimiento accesible, mínimamente invasivo que demostró buenos resultados y buen manejo del dolor con bajo índice de complicaciones.

Objectives: Describe results of the last 11 years in the treatment of trigeminal neuralgia with radiofrequency thermocoagulation, analyze variables related to complications and results. Methods: Retrospective, descriptive, longitudinal, comparative and analytical study. The results of the last 11 years of our service were analyzed by assessing the temperatures of the lesions by assembling two groups, 65° C-70° C and 71 ° C-75° C to analyze their relationship with results and complications. Results: 59 patients were treated in which 74 procedures were performed; the mean age was 59.22 years (± 13.45). Recurrence was observed in 23 procedures with an overall rate of 31%. The average recurrence time was 28.19 months (± 26.21). The average follow-up time was 33.10 months (± 33.49). The average time of pain evolution, prior to the first procedure, was 5.35 years (± 4.37). Analyzing the groups, it was observed that there was no significant statistical relationship (p = 0.74) between the group of patients from 65ºC-70ºC and the group from 71ºC-75ºC and recurrence. No statistically significant relationship was observed between the 65ºC-70ºC group and the 71ºC-75ºC group and recurrence time (p = 0.12). More patients with immediate hypoaesthesia were observed in the group of patients from 65ºC-70ºC, without statistical significance (p = 0.47). Conclusion: Gasser's ganglion radiofrequency thermocoagulation is an accessible, minimally invasive procedure that demonstrated good results and good pain management with a low complication rate

Humans , Trigeminal Neuralgia , Temperature , Therapeutics , Trigeminal Ganglion , Electrocoagulation , Pain Management , Neuralgia
Rev. cuba. med. mil ; 49(2): e407, abr.-jun. 2020. fig
Article in Spanish | LILACS, CUMED | ID: biblio-1138995


Introducción: Los linfomas no Hodgkin (LNH) forman un grupo heterogéneo de neoplasias linfoides. Actualmente se reporta un aumento global de su incidencia. Estos se originan generalmente en los ganglios linfáticos, aunque pueden aparecer fuera de este, entre los que se describe el linfoma primario del sistema nervioso central, que puede afectar la médula espinal, entre otros. Objetivo: Presentar un paciente con diagnóstico de linfoma no Hodgkin con invasión mielorradicular, condición reportada con muy poca frecuencia. Caso clínico: Paciente de 47 años de edad con historia anterior de salud que comienza con neuralgia intercostal, progresivamente aparecen otros síntomas y signos neurológicos con deterioro de la función motora, se diagnostica linfoma no Hodgkin primario del Sistema Nervioso Central, se le realiza tratamiento y obtiene mejoría de los síntomas y control de la enfermedad. Conclusiones: Con el diagnóstico y tratamiento precoz de las lesiones compresivas del Sistema Nervioso Central, entre estas el LNH se puede lograr el control de la enfermedad y garantizar una adecuada calidad de vida con mejor pronóstico(AU)

Introduction: Non-Hodgkin lymphomas form a heterogeneous group of lymphoid neoplasms; a global increase in its incidence is currently reported. These usually originate in the lymph nodes, although they may appear outside the lymph node, among which primary lymphoma of the central nervous system, which can affect the spinal cord, is described, among others. Objective: To present a patient with a diagnosis of non-Hodgkin lymphoma with myelodradicular invasion, a condition reported very infrequently. Clinical case: A 47-year-old patient with a previous history of health that begins with intercostal neuralgia, other neurological symptoms and signs with impaired motor function appear progressively, primary non-Hodgkin lymphoma of the Central Nervous System is diagnosed, treatment is performed and Obtain improvement of symptoms and disease control. Conclusions: With the diagnosis and early treatment of the compressive lesions of the Central Nervous System, among these the NHL can control the disease and guarantee an adequate quality of life with a better prognosis(AU)

Humans , Male , Middle Aged , Spinal Cord , Lymphoma, Non-Hodgkin , Diagnosis , Lymph Nodes/surgery , Neoplasms , Neuralgia
Rev. méd. hondur ; 88(1): 48-51, ene.- jun. 2020. tab
Article in Spanish | LILACS | ID: biblio-1128559


El dolor neuropático definido como el dolor que se origina como consecuencia de una lesión en el sistema somatosensorial, incluye aproximadamente el 15% de las consultas por dolor. Debido a su diversa etiología y mecanismos fisiopatológicos, el dolor neuropático crea un reto para su manejo. Su relativa frecuencia en la atención primaria se convierte un tema que todo clínico deberá saber diagnosticar, tratar e identificar para su correcta remisión. Se realizó una revisión bibliográfica narrativa a partir de artículos originales, artículos de revisión y guías clínicas encontrados en bases de datos incluyendo PUBMED, HINARI, ScienceDirect y Cochrane Library, para el periodo 2010-2018. El diagnóstico del dolor neuropático se basa en la historia clínica. No se debe retrasar el alivio del dolor con medicamentos de primera línea como ser los antidepresivos tricíclicos e inhibidores de la recaptación de serotonina y noradrenalina...(AU)

Humans , Pain/complications , Pain Measurement , Hypersensitivity , Neuralgia
Rev. argent. neurocir ; 34(2): 76-84, jun. 2020. ilus, tab
Article in Spanish | LILACS, BINACIS | ID: biblio-1123315


Introducción: La Academia Americana de Neurología propone que, para que un paciente sea candidato a descompresiva neurovascular trigeminal (DNV), se debe demostrar la presencia de contacto neurovascular a través de la resonancia magnética (RM). Sin embargo, recientes estudios han demostrado que la sensibilidad de la RM para diagnosticar un conflicto neurovascular (CNV) es muy variable. Estos conceptos antagónicos ubican al neurocirujano ante un verdadero dilema a la hora de tomar decisiones. El objetivo del presente estudio es evaluar la utilidad de la clínica y la RM como factor predictor de un verdadero CNV. Materiales y Métodos: Estudio analítico retrospectivo que incluye a 81 pacientes a los que se les realizó una DNV por neuralgia trigeminal (NT), desde enero de 2013 hasta abril de 2019, en la provincia de Tucumán. Resultados: Al considerar la serie completa: A) Un total de 65 pacientes cursaron con NT Típicas; de estos, 64 (98,5%) presentaron CNV durante la cirugía y B) De las 16 Atípicas, ninguna presentó CNV en el intraoperatorio. Al considerar los pacientes con NT primaria: A) un 98% de los pacientes con clínica de NT típica presentaran CNV en el intraoperatorio y B) hubo un grupo de pacientes donde se evidencio un CNV en el intraoperatorio pero en su RM preoperatoria no se objetivo el mismo (n=15), el valor predictivo negativo de la RM fue sólo un 6%. Conclusión: La clínica del paciente es más efectiva que la RM para decidir si realizar o no una cirugía de DNV.

Introduction: The American Academy of Neurology proposes that, for a patient to be a candidate for trigeminal neurovascular decompression (NVD), the presence of neurovascular contact must be demonstrated through magnetic resonance imaging (MRI). However, recent studies have shown that the sensitivity of MRI to diagnose a neurovascular conflict (NVC) is highly variable. These antagonistic concepts put, the neurosurgeon, in a real dilemma when making decisions about this entity. The aim of this study is to evaluate the usefulness of clinical and MRI as a predictor of a real NVC. Methods: This is a retrospective analytical study including 81 patients undergoing NVD to treat trigeminal neuralgia (TN), from January 2013 to April 2019, in Tucumán. Results: When considering the complete series: A) Of the total of 65 patients who had typical TN, 64 (98.5%) presented NVC during surgery and B) Of the 16 atypical TN, none of then presented NVC during the surgery. When considering patients with primary TN: A) 98% of the patients with typical NT presented a NVC during surgery and B) there was a group of patients where NVC was evidenced during surgery but it wasn`t noticed during the preoperative MRI (n=15), the negative predictive value of the MRI was only 6%. Conclusion: The patient's clinic is more effective than the MRI deciging whether or not to perform NVD surgery.

Humans , Trigeminal Neuralgia , Therapeutics , Neuralgia
Rev. argent. cir ; 112(1): 63-66, mar. 2020. ilus
Article in English, Spanish | LILACS | ID: biblio-1125784


Los tumores retroperitoneales son lesiones infrecuentes. Las tumoraciones nerviosas benignas como los schwannomas representan menos del 3% de ellos, siendo extremadamente raros los que afectan el nervio obturador. Presentamos el caso de un paciente con importante afectación funcional en miembro inferior izquierdo y dolor pélvico, al que se le diagnosticó neoplasia retroperitoneal. Fue intervenido por vía laparoscópica objetivándose la dependencia de la lesión del nervio obturador. Se llevó a cabo una exéresis completa de la lesión preservando parcialmente el nervio. El paciente tuvo una evolución funcional y álgica muy favorable. La anatomía patología reveló la presencia de schwannoma, del denominado subtipo "anciano", sin datos de malignidad. Consideramos que el informe de un caso como este puede ayudar a conocer una patología muy infrecuente y a tener en consideración algunos puntos clave como la técnica de abordaje y la necesidad de preservación de las estructuras nerviosas.

Retroperitoneal tumors are uncommon; benign tumors originating in the nerve cells as schwannomas represent less than 3%, while schwannomas of the obturator nerve are extremely rare. We report the case of a male patient with significant functional compromise of the left lower limb and pelvic pain who was diagnosed with a retroperitoneal tumor. The patient underwent laparoscopic surgery during which the compromise of the obturator nerve was evident. The lesion was completely resected with partial preservation of the nerve. The patient progressed with favorable functional recovery and pain relief. The histopathological examination reported a benign ancient schwannoma. We believe that this case report can help to understand a very rare condition and consider some key points such as the technique of approach and the need for preservation of the nerve structures.

Humans , Male , Aged , Retroperitoneal Neoplasms/surgery , Neurilemmoma/surgery , Obturator Nerve/injuries , Arthroplasty/adverse effects , Magnetic Resonance Spectroscopy/methods , Tomography, X-Ray Computed/methods , Colonoscopy/methods , Laparoscopy/methods , Neuralgia/diagnostic imaging , Neurilemmoma/diagnostic imaging
Article in English | WPRIM | ID: wpr-782067


3) of the pain in domains of tingling/prickling sensation (p=0.024), mechanical allodynia (p=0.027), sudden pain attacks (p=0.018), and thermal hyperalgesia (p=0.002) were significantly more frequent in NMOSD compared to MS patients. Among the patients experiencing pain with a neuropathic component, total pain-related interference (p=0.045) scores were significantly higher in NMOSD patients than in MS patients. In daily life, pain interfered with normal work (p=0.045) and relationships with other people (p=0.039) more often in NMOSD patients than in MS patients. Although pain medication was prescribed more frequently in NMOSD patients, the percentage of patients experiencing medication-related pain relief was lower in those patients.CONCLUSIONS: The severity of neuropathic pain and the pain-related interference in daily life were greater in NMOSD patients than in MS patients. Individualized analgesic management should be considered based on a comprehensive understanding of neuropathic pain in these patients.

Humans , Hyperalgesia , Korea , Multiple Sclerosis , Neuralgia , Neuromyelitis Optica , Referral and Consultation , Sensation , Sex Ratio
Article in Chinese | WPRIM | ID: wpr-880794


OBJECTIVE@#To investigate the effect of escin in relieving chemotherapy-induced peripheral neuropathic pain in rats and explore and the underlying mechanism.@*METHODS@#Eighteen SD rats were randomly divided into 3 groups (@*RESULTS@#The rats in both the escin preconditioning group and escin postconditioning group showed obviously increased thresholds of mechanical allodynia and thermal hyperalgesia as compared with those in the control group (@*CONCLUSIONS@#Escin can alleviate chemotherapy-induced peripheral neuropathic pain in rats possibly by upregulating the expressions of autophagy-related proteins in the spinal cord.

Animals , Antineoplastic Agents/therapeutic use , Autophagy , Escin/therapeutic use , Hyperalgesia/drug therapy , Mice , Neuralgia/drug therapy , Rats , Rats, Sprague-Dawley , Spinal Cord
Clinics ; 75: e1296, 2020. tab, graf
Article in English | LILACS | ID: biblio-1055883


OBJECTIVES: Alcohol for intercostal neuralgia may induce severe injection pain. Although nerve block provided partial pain relief, alcohol might be diluted, and the curative effect decreased when the local anesthetic and alcohol were given at the same point. Therefore, we observed the modified method for intercostal neuralgia, a Two-point method, in which the local anesthetic and alcohol were given at different sites. METHOD: Thirty patients diagnosed with intercostal neuralgia were divided into 2 groups: Single-point group and Two-point group. In the Single-point group, alcohol and local anesthetic were injected at the same point, named the "lesion point", which was the lower edge of ribs and 5 cm away from the midline of the spinous process. In the Two-point group, alcohol was injected at the lesion point, whereas the local anesthetic was administered at the "anesthesia point", which was 3 cm away from the midline of spinous process. RESULTS: After alcohol injection, visual analog scale (VAS) in the Two-point group was lower than the Single-point group, and the satisfaction ratio of patients in the Two-point group was higher (p<0.05). The degree of numbness in the Two-point group was greater than the Single-point group at 1 month and 3 months after operation (p<0.05). However, the long-term effects did not differ. CONCLUSIONS: Local anesthetic was given upstream of the point where alcohol was administered, was a feasible and safe method to relieve pain during the operation, and improved the satisfaction of the patients and curative effect.

Humans , Male , Female , Anesthesia, Local/methods , Anesthetics, Local , Nerve Block/methods , Neuralgia/therapy , Prospective Studies
Braz. j. med. biol. res ; 53(5): e9255, 2020. graf
Article in English | LILACS | ID: biblio-1098115


The neurochemical mechanisms underlying neuropathic pain (NP) are related to peripheral and central sensitization caused by the release of inflammatory mediators in the peripheral damaged tissue and ectopic discharges from the injured nerve, leading to a hyperexcitable state of spinal dorsal horn neurons. The aim of this work was to clarify the role played by cyclooxygenase (COX) in the lesioned peripheral nerve in the development and maintenance of NP by evaluating at which moment the non-steroidal anti-inflammatory drug indomethacin, a non-selective COX inhibitor, attenuated mechanical allodynia after placing one loose ligature around the nervus ischiadicus, an adaptation of Bennett and Xie's model in rodents. NP was induced in male Wistar rats by subjecting them to chronic constriction injury (CCI) of the nervus ischiadicus, placing one loose ligature around the peripheral nerve, and a sham surgery (without CCI) was used as control. Indomethacin (2 mg/kg) or vehicle was intraperitoneally and acutely administered in each group of rats and at different time windows (1, 2, 4, 7, 14, 21, and 28 days) after the CCI or sham surgical procedures, followed by von Frey's test for 30 min. The data showed that indomethacin decreased the mechanical allodynia threshold of rats on the first, second, and fourth days after CCI (P<0.05). These findings suggested that inflammatory mechanisms are involved in the induction of NP and that COX-1 and COX-2 are involved in the induction but not in the maintenance of NP.

Animals , Male , Rats , Sciatic Nerve/injuries , Pain Measurement , Indomethacin/administration & dosage , Neuralgia/drug therapy , Rats, Wistar , Rats, Sprague-Dawley , Pain Threshold , Constriction , Disease Models, Animal , Neuralgia/etiology
Biol. Res ; 53: 36, 2020. tab, graf
Article in English | LILACS | ID: biblio-1131882


BACKGROUND: To investigate the thalamic neurotransmitters and functional connections in the development of chronic constriction injury (CCI)-induced neuropathic pain. METHODS: The paw withdrawal threshold was measured by mechanical stimulation the right hind paw with the von frey hair in the rats of CCI-induced neuropathic pain. The N-acetylaspartate (NAA) and Glutamate (Glu) in thalamus were detected by magnetic resonance spectrum (MRS) process. The thalamic functional connectivity with other brain regions was scanned by functional magnetic resonance image (fMRI). RESULTS: The paw withdrawal threshold of the ipsilateral side showed a noticeable decline during the pathological process. Increased concentrations of Glu and decreased levels of NAA in the thalamus were significantly correlated with mechanical allodynia in the neuropathic pain states. The thalamic regional homogeneity (ReHo) decreased during the process of neuropathic pain. The functional connectivity among the thalamus with the insula and somatosensory cortex were significantly increased at different time points (7, 14, 21 days) after CCI surgery. CONCLUSION: Our study suggests that dynamic changes in thalamic NAA and Glu levels contribute to the thalamic functional connection hyper-excitation during CCI-induced neuropathic pain. Enhanced thalamus-insula functional connection might have a significant effect on the occurrence of neuropathic pain.

Animals , Rats , Thalamus/metabolism , Wounds and Injuries/physiopathology , Neurotransmitter Agents/metabolism , Neuralgia , Thalamus/physiopathology , Aspartic Acid/analogs & derivatives , Aspartic Acid/metabolism , Glutamic Acid/metabolism , Constriction , Hyperalgesia
Odontol. vital ; (31): 7-10, jul.-dic. 2019. graf
Article in Spanish | LILACS, BBO, SaludCR | ID: biblio-1091421


Resumen Muchos pacientes presentan dolores de cabeza primarios que no son tomados en cuenta en la consulta diaria de odontología. Es común que los asocien a un dolor referido a la articulación témporomandibular, inclusive a un dolor dental de origen no odontogénico, donde se ve incluida esta estructura.

Abstract A lot of the patients present primary headaches and most of the time, they are not connected in the general practice of dentistry, it´s common that the patient relates the pain to the symptom of TMJ referral pain, or another dental pain non odontogenic, muscular or others.

Humans , Female , Adult , Temporomandibular Joint , Migraine with Aura/diagnosis , Neuralgia/drug therapy , Bruxism , Nerve Block
Rev. bras. anestesiol ; 69(6): 594-604, nov.-Dec. 2019. tab
Article in English | LILACS | ID: biblio-1057482


Abstract Background and objectives: Calcitonin is a polypeptide hormone regulating the metabolism of calcium in the body. For many years calcitonin has been used to maintain and improve bone mineral density and to reduce the fracture rate. Many studies showed that calcitonin had analgesic role in several painful circumstances. This pain-ameliorating effect is irrelevant to its osteoclastic inhibitory effect and mechanisms like altering Na+ channel and serotonin receptor expression or hypothesis including the endorphin-mediated mechanism were used to explain this effect. In this study we performed a thorough review on the role of calcitonin as an analgesic agent in different scenarios and investigated the fact that calcitonin can be a feasible medication to relieve pain. Method: Many studies focused on the analgesic effect of calcitonin in several painful circumstances, including acute pains related to vertebral fractures, metastasis, migraine and reflex sympathetic dystrophy as well as neuropathic pains related to spinal injuries or diabetes, and phantom pain. Also, calcitonin was showed to be a useful additive to local anesthesia in the case of controlling postoperative pain or trigeminal neuralgia more effectively. However we faced some contradictory data for conditions like lumbar canal stenosis, complex regional pain syndrome, phantom pain and malignancies. Conclusion: This study showed that calcitonin could be helpful analgesic agent in different painful situations. Calcitonin can be considered an eligible treatment for acute pains related to vertebral fractures and a feasible alternative for the treatment of the acute and chronic neuropathic pains where other medications might fail.

Resumo Justificativa e objetivos: A calcitonina é um hormônio polipeptídico que regula o metabolismo do cálcio no organismo. Por muitos anos a calcitonina tem sido usada para manter e melhorar a densidade mineral óssea e reduzir a incidência de fraturas. Muitos estudos mostraram que a calcitonina teve efeito analgésico em várias condições físicas de dor. Esse efeito de melhoria da dor é irrelevante diante de seu efeito inibidor osteoclástico e de mecanismos, tais como a alteração do canal de Na+ e da expressão do receptor de serotonina, inclusive a hipótese do mecanismo mediado pela endorfina, que foram usados para explicar esse efeito. Neste estudo, fizemos uma revisão completa sobre o papel da calcitonina como agente analgésico em diferentes cenários e investigamos o fato de que a calcitonina pode ser uma medicação viável para aliviar a dor. Método: Muitos estudos centraram no efeito analgésico da calcitonina em várias condições de dor, inclusive dores agudas relacionadas a fraturas vertebrais, metástases, enxaqueca e distrofia simpática reflexa, bem como dores neuropáticas relacionadas a lesões medulares ou ao diabetes e dor fantasma. Além disso, a calcitonina mostrou ser um aditivo útil à anestesia local para o controle mais efecaz da dor pós-operatória ou neuralgia do trigêmeo. Porém, nos deparamos com alguns dados contraditórios em condições como estenose do canal lombar, síndrome complexa da dor regional, dor fantasma e malignidades. Conclusão: Este estudo mostrou que a calcitonina pode ser um analgésico útil em diferentes condições de dor. A calcitonina pode ser considerada um tratamento elegível para as dores agudas relacionadas a fraturas vertebrais e uma opção viável para o tratamento das dores neuropáticas agudas e crônicas em que outros medicamentos podem falhar.

Humans , Animals , Calcitonin/therapeutic use , Analgesics/therapeutic use , Calcitonin/pharmacology , Acute Pain/etiology , Acute Pain/physiopathology , Acute Pain/drug therapy , Chronic Pain/etiology , Chronic Pain/physiopathology , Chronic Pain/drug therapy , Analgesics/pharmacology , Neuralgia/etiology , Neuralgia/physiopathology , Neuralgia/drug therapy
Rev. Assoc. Med. Bras. (1992) ; 65(12): 1464-1469, Dec. 2019. tab, graf
Article in English | LILACS | ID: biblio-1057095


SUMMARY INTRODUCTION Type 2 diabetes mellitus compromises physical, psychological, economic, and social life. OBJECTIVES To identify and compare the quality of life, depression, functional performance, and physical activity in patients with type 2 diabetes mellitus who use insulin or not. METHODS A observational, descriptive, cross-sectional, comparative study involving 100 patients (50 use insulin and 50 do not) from a Teaching Hospital. Questionnaires used: Identification and Socioeconomic Profile; SF-36; Hospital Anxiety and Depression Scale; Visual Analogue Scale for Pain; Canadian Occupational Performance Measure, and International Physical Activity Questionnaire. RESULTS Sample composed predominantly by middle-aged, female, married, retired, and with incomplete elementary school individuals. There is impairment in all domains of quality of life, being more intense in functional capacity, physical limitations, pain, social aspects, limitation by emotional aspects, and mental health (P<0.05). There is a significant prevalence of anxiety or depressive symptoms in the groups, especially in those using insulin. However, the occurrence of the corresponding psychiatric disorders is unlikely (P<0.05). There was no significant difference in neuropathic pain between the groups (P=0.2296). Functional impairment is similar in both groups regarding self-care activities (P=0.4494) and productivity (P=0.5759), with a greater deterioration of leisure time in patients on insulin (P=0.0091). Most of them practice physical activity, predominantly walking, with no significant difference when comparing the groups (P>0.05), as well as in the other modalities. CONCLUSION Insulinized patients present greater impairment of functional capacity and socialization, as well as greater neuropathic pain, anxiety, and depressive symptoms.

RESUMO INTRODUÇÃO Diabetes mellitus tipo 2 compromete física, psicológica, econômica e socialmente. OBJETIVOS Identificar e comparar qualidade de vida, depressão, desempenho funcional e exercício físico em pacientes com diabetes mellitus tipo 2 insulinizados ou não. MÉTODOS Estudo individuado, observacional, descritivo, transversal, comparativo envolvendo 100 pacientes (50 utilizam insulina e 50 não) em um hospital escola. Instrumentos utilizados: Ficha de Identificação e Perfil Socioeconômico; SF-36; Escala Hospitalar de Ansiedade e Depressão; Escala Visual Analógica de Dor; Medida Canadense de Desempenho Ocupacional e Questionário Internacional de Atividade Física. RESULTADOS Amostra composta, predominantemente, por indivíduos de meia-idade, sexo feminino, casados, ensino fundamental incompleto e aposentados. Há comprometimento de todos os domínios da qualidade de vida, sendo mais intenso nos insulinizados em capacidade funcional, limitação por aspectos físicos, dor, aspectos sociais, limitação por aspectos emocionais e saúde mental (P<0,05). Importante prevalência de sintomas ansiosos ou depressivos nos grupos, principalmente nos em uso de insulina, porém a ocorrência dos transtornos psiquiátricos correspondentes é improvável (P<0,05). Não houve diferença significativa da DNP entre os grupos (P=0,2296). O prejuízo da funcionalidade é semelhante em relação a atividades de autocuidado (P=0,4494) e produtividade (P=0,5759) nos dois grupos, havendo maior deterioração do lazer em usuários de insulina (P=0,0091). A maioria pratica atividade física, tendo a caminhada a maior adesão, sem diferença significativa ao comparar os grupos (P>0,05), repetindo-se nas demais modalidades. CONCLUSÃO Pacientes insulinizados apresentaram maior prejuízo da capacidade funcional e na socialização, assim como referem maiores dores neuropáticas e sintomas ansiosos e depressivos.

Humans , Male , Female , Adult , Aged , Quality of Life/psychology , Diabetes Mellitus, Type 2/physiopathology , Diabetes Mellitus, Type 2/psychology , Insulin/therapeutic use , Anxiety/physiopathology , Anxiety/psychology , Psychiatric Status Rating Scales , Reference Values , Socioeconomic Factors , Pain Measurement , Exercise/psychology , Mental Health , Cross-Sectional Studies , Surveys and Questionnaires , Statistics, Nonparametric , Depression/physiopathology , Depression/psychology , Diabetes Mellitus, Type 2/drug therapy , Middle Aged , Neuralgia/psychology
Rev. Hosp. Ital. B. Aires (2004) ; 39(3): 81-85, sept. 2019.
Article in Spanish | LILACS | ID: biblio-1048229


El dolor crónico constituye un reto terapéutico especial. Se presenta una revisión narrativa sobre el papel del tratamiento de oxigenación hiperbárica (TOHB) en el tratamiento del dolor neuropático, y sus aplicaciones en dolor crónico, síndromes neurosensitivos disfuncionales y oncodolor. El conocimiento de las indicaciones de TOHB en algiología y su aplicación en la práctica médica puede contribuir a mejorar la calidad de vida del paciente. (AU)

Chronic pain represents a special therapeutic challenge. We present a narrative review on the role of Hyperbaric Oxygen Therapy (HBOT) in the treatment of neuropathic pain, and its applications in chronic pain, dysfunctional neurosensitive syndromes and oncological pain. The knowledge of the indications of HBOT in algiology and its application in medical practice can contribute to improve the quality of life of the patient. (AU)

Chronic Pain/therapy , Hyperbaric Oxygenation/methods , Phantom Limb/therapy , Quality of Life , Reflex Sympathetic Dystrophy/therapy , Vascular Headaches/therapy , Brain Diseases/therapy , Facial Pain/therapy , Fibromyalgia/therapy , Causalgia/therapy , Diabetic Neuropathies/therapy , Edema/therapy , Neuralgia, Postherpetic/therapy , Chronic Pain/epidemiology , Cancer Pain/therapy , Hyperbaric Oxygenation/trends , Analgesia/methods , Inflammation/therapy , Neuralgia/therapy