ResearchPad - Anesthesiology and Pain Medicine https://www.researchpad.co Default RSS Feed en-us © 2020 Newgen KnowledgeWorks <![CDATA[Delayed Neurological Recovery After Ultrasound-Guided Brachial Plexus Block: A Case Report]]> https://www.researchpad.co/product?articleinfo=N21798bcb-2ec4-4a6a-a8d7-a134bba12dbe

Introduction

Brachial plexus blocks are frequently practiced and safe mode of anaesthsia. Although minor complications may occur, major complications are a rarity. However, we report a rare case of prolonged supraclavicular brachial plexus block which required almost 4 months to recover without a perceivable cause.

Case Presentation

A 22-year-old gentleman posted for open reduction and internal fixation of both forearm bones was administered an ultrasound-guided supraclavicular brachial plexus block. The intra-operative period was uneventful. However, the block persisted for a very prolonged period of time. All perceivable causes were ruled out. A total of 19 weeks was required for the entire block to regress with no residual neurological deficits thereafter.

Conclusion

Although peripheral neuropathies are known complications of peripheral nerve blocks, such a prolonged brachial plexus block is a rare event. The only plausible cause for the patient’s condition could have been the prolonged drug effect; however, it has been rarely documented.

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<![CDATA[Sex and Gender are Not the Same: Why Identity Is Important for People Living with HIV and Chronic Pain]]> https://www.researchpad.co/product?articleinfo=N296a692a-46cc-45b3-8e2c-4e7f28a2f679

Background

Sex differences in pain sensitivity have been well documented, such that women often report greater sensitivity than men. However, clinical reports highlighting sex differences often equate gender and sex. This is a particularly critical oversight for those whose gender identity is different than their genetic sex.

Methods

This preliminary study sets to analyze differences in pain responses between cisgender and transgender individuals living with HIV and chronic pain. A total of 51 African-American participants (24 cisgender men, 20 cisgender women, 7 transgender women) with similar socioeconomic status were recruited. Genetic sex, gender identity, depression and anxiety, pain severity, pain interference and pain-related stigma were recorded. Participants also completed a quantitative sensory testing battery to assess pain in response to noxious heat and mechanical stimuli.

Results

Transgender women and cisgender women demonstrated a greater magnitude of temporal summation for heat pain stimuli or mechanical stimuli compared to cisgender men. Specifically, transgender women reported greater mechanical summation than either cisgender women or cisgender men. Transgender women and cisgender women similarly reported greater chronic pain severity compared to cisgender men.

Conclusion

These data support the notion that gender identity may play a more significant role in pain sensation than genetic sex. These results further maintain that not only gender identity and genetic sex are distinct variables but that treatment should be based on identity as opposed to genetic sex.

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<![CDATA[Balance Control in Patients with Subacute Non-Specific Low Back Pain, with and without Lumbar Instability: A Cross-Sectional Study]]> https://www.researchpad.co/product?articleinfo=Na74791d0-a1b3-4d0b-b872-0feeacbdb4ad

Background

Patients with low back pain (LBP) have poorly coordinated neuromuscular control, which may alter the normal postural stability of the spine. Altered movement control may occur at any stage of LBP.

Purpose

(1) To identify differences in balance control and proprioceptive sense between subacute non-specific LBP (NSLBP) patients with and without lumbar instability (LI) and healthy subjects and (2) to investigate the correlation between factors of motor control deficits and balance.

Patients and Methods

Thirty-six participants matched by gender, age, and body mass index (BMI) were allocated into three groups of 12: subacute NSLBP patients with LI, subacute NSLBP patients without LI, and healthy subjects. Balance, proprioceptive sense, pain, functional disability, and fear of movement were evaluated.

Results

Subacute NSLBP patients with LI exhibited greater impairments in balance control, proprioceptive sense, and functional ability than patients without LI (p<0.05). Subacute NSLBP patients showed more impairments in balance control, proprioceptive sense, and fear of movement than healthy subjects (p<0.001), with the following effect sizes (partial η2) for static balance on stable and unstable surface: 0.597 and 0.560, anticipatory balance: 0.417, and dynamic balance: 0.536; proprioceptive sense: 0.676; and fear of movement: 0.379. Significant fair correlations were found between (1) static balance and proprioceptive sense, functional disability, and fear of movement; (2) functional reach test (FRT) and pain; and (3) the five times sit to stand test (FTSTS) and functional disability.

Conclusion

Subacute NSLBP patients with LI showed greater impairment in balance control than patients without LI. Reduced proprioceptive sense, increased pain, functional disability, and fear of movement were fairly related to impaired balance.

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<![CDATA[Management of pain in patients with temporomandibular disorder (TMD): challenges and solutions]]> https://www.researchpad.co/product?articleinfo=5bfb30d6d5eed0c48496381b

Thanks to advances in neuroscience, biopsychosocial models for diagnostics and treatment (including physical, psychological, and pharmacological therapies) currently have more clinical support and scientific growth. At present, a conservative treatment approach prevails over surgery, given it is less aggressive and usually results in satisfactory clinical outcomes in mild–moderate temporomandibular disorder (TMD). The aim of this review is to evaluate the recent evidence, identify challenges, and propose solutions from a clinical point of view for patients with craniofacial pain and TMD. The treatment we propose is structured in a multi-modal approach based on a biobehavioral approach that includes medical, physiotherapeutic, psychological, and dental treatments. We also propose a new biobehavioral model regarding pain perception and motor behavior for the diagnosis and treatment of patients with painful TMD.

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<![CDATA[Blinatumomab retreatment after relapse in patients with relapsed/refractory B-precursor acute lymphoblastic leukemia]]> https://www.researchpad.co/product?articleinfo=5b4ad4a6463d7e6c275999f9 ]]> <![CDATA[Local anesthetics for brain tumor resection: current perspectives]]> https://www.researchpad.co/product?articleinfo=5b4ac456463d7e6b46cb191c

This review summarizes the added value of local anesthetics in patients undergoing craniotomy for brain tumor resection, which is a procedure that is carried out frequently in neurosurgical practice. The procedure can be carried out under general anesthesia, sedation with local anesthesia or under local anesthesia only. Literature shows a large variation in the postoperative pain intensity ranging from no postoperative analgesia requirement in two-thirds of the patients up to a rate of 96% of the patients suffering from severe postoperative pain. The only identified causative factor predicting higher postoperative pain scores is infratentorial surgery. Postoperative analgesia can be achieved with multimodal pain management where local anesthesia is associated with lower postoperative pain intensity, reduction in opioid requirement and prevention of development of chronic pain. In awake craniotomy patients, sufficient local anesthesia is a cornerstone of the procedure. An awake craniotomy and brain tumor resection can be carried out completely under local anesthesia only. However, the use of sedative drugs is common to improve patient comfort during craniotomy and closure. Local anesthesia for craniotomy can be performed by directly blocking the six different nerves that provide the sensory innervation of the scalp, or by local infiltration of the surgical site and the placement of the pins of the Mayfield clamp. Direct nerve block has potential complications and pitfalls and is technically more challenging, but mostly requires lower total doses of the local anesthetics than the doses required in surgical-site infiltration. Due to a lack of comparative studies, there is no evidence showing superiority of one technique versus the other. Besides the use of other local anesthetics for analgesia, intravenous lidocaine administration has proven to be a safe and effective method in the prevention of coughing during emergence from general anesthesia and extubation, which is especially appreciated after brain tumor resection.

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<![CDATA[Effect of bupivacaine and adjuvant drugs for regional anesthesia on nerve tissue oximetry and nerve blood flow]]> https://www.researchpad.co/product?articleinfo=5b4a8233463d7e6681b4b2fc

Background

Nerve blood flow has a critical role in acute and chronic pathologies in peripheral nerves. Influences of local anesthetics and adjuvants on tissue perfusion and oxygenation are deemed as relevant factors for nerve damage after peripheral regional anesthesia. The link between low tissue perfusion due to local anesthetics and resulting tissue oxygenation is unclear.

Methods

Combined tissue spectrophotometry and laser-Doppler flowmetry were used to assess nerve blood flow in 40 surgically exposed median nerves in pigs, as well as nerve tissue oximetry for 60 min. After baseline measurements, test solutions saline (S), bupivacaine (Bupi), bupivacaine with epinephrine (BupiEpi), and bupivacaine with clonidine (BupiCloni) were applied topically.

Results

Bupivacaine resulted in significant decrease in nerve blood flow, as well as tissue oximetry values, compared with saline control. Addition of epinephrine resulted in a rapid, but nonsignificant, reduction of nerve blood flow and extensive lowering of tissue oximetry levels. The use of clonidine resulted in a reduction of nerve blood flow, comparable to bupivacaine alone (relative blood flow at T60 min compared with baseline, S: 0.86 (0.67–1.18), median (25th–75th percentile); Bupi: 0.33 (0.25–0.60); BupiCloni: 0.43 (0.38–0.63); and BupiEpi: 0.41(0.30–0.54). The use of adjuvants did not result in any relevant impairment of tissue oximetry values (saturation values in percent at T60, S: 91.5 [84–95]; Bupi: 76 [61–86]; BupiCloni: 84.5 [76–91]; and BupiEpi: 91 [56–92]).

Conclusion

The application of bupivacaine results in lower nerve blood flow, but does not induce relevant ischemia. Despite significant reductions in nerve blood flow, the addition of clonidine or epinephrine to bupivacaine had no significant impact on nerve tissue oximetry compared with bupivacaine alone. Nerve ischemia due to local anesthetics is not enhanced by the adjuvants clonidine or epinephrine.

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<![CDATA[Headache following head injury: a population-based longitudinal cohort study (HUNT)]]> https://www.researchpad.co/product?articleinfo=5b4a49e6463d7e44fe5eb45b

Background

Headache is the most frequent symptom following head injury, but long-term follow-up of headache after head injury entails methodological challenges. In a population-based cohort study, we explored whether subjects hospitalized due to a head injury more often developed a new headache or experienced exacerbation of previously reported headache compared to the surrounding population.

Methods

This population-based historical cohort study included headache data from two large epidemiological surveys performed with an 11-year interval. This was linked with data from hospital records on exposure to head injury occurring between the health surveys. Participants in the surveys who had not been hospitalized because of a head injury comprised the control group. The head injuries were classified according to the Head Injury Severity Scale (HISS). Multinomial logistic regression was performed to investigate the association between head injury and new headache or exacerbation of pre-existing headache in a population with known pre-injury headache status, controlling for potential confounders.

Results

The exposed group consisted of 294 individuals and the control group of 25,662 individuals. In multivariate analyses, adjusting for age, sex, anxiety, depression, education level, smoking and alcohol use, mild head injury increased the risk of new onset headache suffering (OR 1.74, 95% CI 1.05–2.87), stable headache suffering (OR 1.70, 95% CI 1.15–2.50) and exacerbation of previously reported headache (OR 1.93, 95% CI 1.24–3.02). The reference category was participants without headache in both surveys.

Conclusion

Individuals hospitalized due to a head injury were more likely to have new onset and worsening of pre-existing headache and persistent headache, compared to the surrounding general population. The results support the entity of the ICHD-3 beta diagnosis “persistent headache attributed to traumatic injury to the head”.

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<![CDATA[Safety and efficacy of neublastin in painful lumbosacral radiculopathy: a randomized, double-blinded, placebo-controlled phase 2 trial using Bayesian adaptive design (the SPRINT trial)]]> https://www.researchpad.co/product?articleinfo=5bf49228d5eed0c484763afb

Supplemental Digital Content is Available in the Text.

Neublastin showed some evidence of pain relief among patients with painful lumbosacral radiculopathy; however, there was no clear dose–response relationship.

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<![CDATA[miR-34c-5p functions as pronociceptive microRNA in cancer pain by targeting Cav2.3 containing calcium channels]]> https://www.researchpad.co/product?articleinfo=5bf4922ad5eed0c484763b2a

Supplemental Digital Content is Available in the Text.

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<![CDATA[Cebranopadol, a novel first-in-class analgesic drug candidate: first experience in patients with chronic low back pain in a randomized clinical trial]]> https://www.researchpad.co/product?articleinfo=5bf4922bd5eed0c484763b7f

Supplemental Digital Content is Available in the Text.

Cebranopadol, a novel first-in-class combination of nociceptin/orphanin FQ and opioid peptide receptor agonism, as a potential treatment for moderate to severe chronic low back pain.

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<![CDATA[New model of vincristine-induced neuropathic pain in children: a first step towards prediction and prevention]]> https://www.researchpad.co/product?articleinfo=5bf49226d5eed0c484763ad0 ]]> <![CDATA[PKM2 is involved in neuropathic pain by regulating ERK and STAT3 activation in rat spinal cord]]> https://www.researchpad.co/product?articleinfo=5b4a0487463d7e3e66f5dd72

Background

Pyruvate kinase isozymes M2 (PKM2), as a member of pyruvate kinase family, plays a role of glycolytic enzyme in glucose metabolism. It also functions as protein kinase in cell proliferation, signaling, immunity, and gene transcription. In this study, the role of PKM2 in neuropathic pain induced by chronic constriction injury (CCI) was investigated.

Methods

Rats were randomly grouped to establish CCI models. PKM2, extracellular regulated protein kinases (EKR), p-ERK, signal transducers and activators of transcription (STAT3), p-STAT3, phosphoinositide 3-kinase/protein kinase B (PI3K/AKT) and p-PI3K/AKT proteins expression in spinal cord was examined by Western blot analysis. Cellular location of PKM2 was examined by immunofluorescence. Knockdown of PKM2 was achieved by intrathecal injection of specific small interfering RNA (siRNA). Von Frey filaments and radiant heat tests were performed to determine mechanical allodynia and thermal hyperalgesia respectively. Lactate and adenosine triphosphate (ATP) contents were measured by specific kits. Tumor necrosis factor alpha (TNF-α) and interleukin-1 beta (IL-1β) levels were detected by ELISA kits.

Results

CCI markedly increased PKM2 level in rat spinal cord. Double immunofluorescent staining showed that PKM2 co-localized with neuron, astrocyte, and microglia. Intrathecal injection of PKM2 siRNA not only attenuated CCI-induced ERK and STAT3 activation, but also attenuated mechanical allodynia and thermal hyperalgesia induced by CCI. However, PKM2 siRNA failed to inhibit the activation of AKT. In addition, PKM2 siRNA significantly suppressed the production of lactate and pro-inflammatory mediators.

Conclusion

Our findings demonstrate that inhibiting PKM2 expression effectively attenuates CCI-induced neuropathic pain and inflammatory responses in rats, possibly through regulating ERK and STAT3 signaling pathway.

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<![CDATA[Elevated Production of Nociceptive CC Chemokines and sE-Selectin in Patients With Low Back Pain and the Effects of Spinal Manipulation]]> https://www.researchpad.co/product?articleinfo=5bf1b0a5d5eed0c484d2880d <![CDATA[Patients With Knee Osteoarthritis Who Score Highly on the PainDETECT Questionnaire Present With Multimodality Hyperalgesia, Increased Pain, and Impaired Physical Function]]> https://www.researchpad.co/product?articleinfo=5bf1b0a3d5eed0c484d287a5 <![CDATA[Clinical signs and electroencephalographic patterns of emergence from sevoflurane anaesthesia in children]]> https://www.researchpad.co/product?articleinfo=5bf1b09ed5eed0c484d286db <![CDATA[Sensory phenotype and risk factors for painful diabetic neuropathy: a cross-sectional observational study]]> https://www.researchpad.co/product?articleinfo=5b45c189463d7e5426b74cd5

Supplemental Digital Content is Available in the Text.

Cross-sectional observational study in a cohort of 232 diabetic polyneuropathy patients confirmed higher severity of neuropathy and predominant loss-of-function sensory profile in painful cases.

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<![CDATA[Response to duloxetine in chronic low back pain: exploratory post hoc analysis of a Japanese Phase III randomized study]]> https://www.researchpad.co/product?articleinfo=5b432a46463d7e234194a95a

Purpose

Duloxetine is efficacious for chronic low back pain (CLBP). This post hoc analysis of a Japanese randomized, placebo-controlled trial (ClinicalTrials.gov, NCT01855919) assessed whether patients with CLBP with early pain reduction or treatment-related adverse events of special interest (TR-AESIs; nausea, somnolence, constipation) have enhanced responses to duloxetine.

Patients and methods

Patients (N = 456) with CLBP for ≥6 months and Brief Pain Inventory (BPI) average pain severity score of ≥4 were randomized (1:1) to duloxetine 60 mg/day or placebo for 14 weeks. Primary outcome was change from baseline in BPI average pain severity score (pain reduction). Subgroup analyses included early pain reduction (≥30%, 10%–30%, or <10% at Week 4) and early TR-AESIs (with or without TR-AESIs by Week 2). Measures included changes from baseline in BPI average pain severity score and BPI Interference scores (quality of life; QOL), and response rate (≥30% or ≥50% pain reduction at Week 14).

Results

Patients with ≥30% early pain reduction (n = 108) or early TR-AESIs (n = 50) had significantly greater improvements in pain and QOL than placebo-treated patients (n = 226), whereas patients with 10%–30% (n = 63) or <10% (n = 48) pain reduction did not; patients without early TR-AESIs (n = 180) had significant improvements in pain at Week 14. Response rates (≥30%/≥50% pain reduction) were 94.4%/82.4%, 66.7%/49.2%, and 25.0%/18.8% for patients with ≥30%, 10%–30%, and <10% early pain reduction, respectively, 74.0%/64.0% for patients with early TR-AESIs, 67.2%/54.4% for patients without early TR-AESIs, and 52.2%/39.4% for placebo.

Conclusion

Early pain reduction or TR-AESIs may predict which CLBP patients are most likely to respond to duloxetine with improvements in pain and QOL.

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<![CDATA[Epac–protein kinase C alpha signaling in purinergic P2X3R-mediated hyperalgesia after inflammation]]> https://www.researchpad.co/product?articleinfo=5bccad9840307c364ce7ade0 <![CDATA[Deficits in pain perception in borderline personality disorder: results from the thermal grill illusion]]> https://www.researchpad.co/product?articleinfo=5bcbfb6b40307c58a99fb39c