1
|
Bai Y, Han S, Guan JY, Lin J, Zhao MG, Liang GB. Contralateral C7 nerve transfer in the treatment of upper-extremity paralysis: a review of anatomical basis, surgical approaches, and neurobiological mechanisms. Rev Neurosci 2022; 33:491-514. [PMID: 34979068 DOI: 10.1515/revneuro-2021-0122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 11/27/2021] [Indexed: 11/15/2022]
Abstract
The previous three decades have witnessed a prosperity of contralateral C7 nerve (CC7) transfer in the treatment of upper-extremity paralysis induced by both brachial plexus avulsion injury and central hemiplegia. From the initial subcutaneous route to the pre-spinal route and the newly-established post-spinal route, this surgical operation underwent a series of innovations and refinements, with the aim of shortening the regeneration distance and even achieving direct neurorrhaphy. Apart from surgical efforts for better peripheral nerve regeneration, brain involvement in functional improvements after CC7 transfer also stimulated scientific interest. This review summarizes recent advances of CC7 transfer in the treatment of upper-extremity paralysis of both peripheral and central causes, which covers the neuroanatomical basis, the evolution of surgical approach, and central mechanisms. In addition, motor cortex stimulation is discussed as a viable rehabilitation treatment in boosting functional recovery after CC7 transfer. This knowledge will be beneficial towards improving clinical effects of CC7 transfer.
Collapse
Affiliation(s)
- Yang Bai
- Department of Neurosurgery, General Hospital of Northern Theater Command, No. 83 Wenhua Road, Shenhe District, Shenyang 110015, China
| | - Song Han
- Department of Neurosurgery, General Hospital of Northern Theater Command, No. 83 Wenhua Road, Shenhe District, Shenyang 110015, China
| | - Jing-Yu Guan
- Department of Neurosurgery, General Hospital of Northern Theater Command, No. 83 Wenhua Road, Shenhe District, Shenyang 110015, China
| | - Jun Lin
- Department of Neurosurgery, General Hospital of Northern Theater Command, No. 83 Wenhua Road, Shenhe District, Shenyang 110015, China
| | - Ming-Guang Zhao
- Department of Neurosurgery, General Hospital of Northern Theater Command, No. 83 Wenhua Road, Shenhe District, Shenyang 110015, China
| | - Guo-Biao Liang
- Department of Neurosurgery, General Hospital of Northern Theater Command, No. 83 Wenhua Road, Shenhe District, Shenyang 110015, China
| |
Collapse
|
2
|
Neuropathic Pain Related to Peripheral Neuropathies According to the IASP Grading System Criteria. Brain Sci 2020; 11:brainsci11010001. [PMID: 33374929 PMCID: PMC7821938 DOI: 10.3390/brainsci11010001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 12/16/2020] [Accepted: 12/17/2020] [Indexed: 12/26/2022] Open
Abstract
Neuropathic pain is defined as pain caused by a lesion or disease of the somatosensory system. Neuropathic pain represents a broad category of pain conditions, common complications of peripheral neuropathies, which are characterized by a combination of positive symptoms, including paresthesia and/or dysesthesia and sensory deficits in the painful area. In the present paper, we aimed to assess neuropathic pain frequency and clinical characteristics of peripheral neuropathies due to different aetiologies according to grading system criteria of the International Association for the Study of Pain for a definitive diagnosis of neuropathic pain. Epidemiological studies applying these criteria have been conducted in patients with diabetes, brachial plexus injury, and other traumatic nerve injuries. Neuropathic pain was diagnosed in 37–42% of patients with diabetic peripheral neuropathy, 56% of patients with brachial plexus injury, and 22% of patients with intercostobrachial neuropathy. The most frequent neuropathic pain type was ongoing pain (described as burning or pressing), followed by paroxysmal pain (electric shock-like sensations) and allodynia (pain evoked by brushing and pressure). By providing information on the frequency, clinical signs, and variables associated with neuropathic pain due to different aetiologies, these studies contribute to improving the clinical management of this condition.
Collapse
|
3
|
Huo BB, Zheng MX, Hua XY, Shen J, Wu JJ, Xu JG. Brain Metabolism in Rats with Neuropathic Pain Induced by Brachial Plexus Avulsion Injury and Treated via Electroacupuncture. J Pain Res 2020; 13:585-595. [PMID: 32273747 PMCID: PMC7106655 DOI: 10.2147/jpr.s232030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Accepted: 02/19/2020] [Indexed: 12/13/2022] Open
Abstract
PURPOSE Brain organisation is involved in the mechanism of neuropathic pain. Acupuncture is a common clinical practise in traditional Chinese medicine for the treatment of chronic pain. This study explored electroacupuncture's effects on brain metabolism following brachial plexus avulsion injury (BPAI)-induced pain. METHODS A total of 32 female rats were randomised into a normal group, model group, sham electroacupuncture group, and electroacupuncture group. A pain model was included via right BPAI. The electroacupuncture intervention at cervical "Jiaji" points (C5-7) was performed for 11 weeks. The mechanical withdrawal threshold of the non-injured (left) forepaw was measured at the baseline and on days 3, 7, 14, 21, 28, 56, 84, and 112 subsequent to BPAI. Positron emission tomography (PET) was applied to explore metabolic changes on days 28, 84, and 112. RESULTS After electroacupuncture, the mechanical withdrawal threshold of the left forepaws was significantly elevated and the effect persisted until 4 weeks after the intervention ceased (p<0.05 or p<0.001). In the sensorimotor-related brain regions, standardised uptake values in the bilateral somatosensory and motor cortices were observed in the electroacupuncture group. Metabolism particularly increased in the right somatosensory cortex. Metabolism changes also occurred in the pain-related brain regions and emotion- and cognition-related brain regions. CONCLUSION The present study demonstrated the beneficial effects of electroacupuncture for relieving BPAI-induced neuropathic pain in rats. Electroacupuncture intervention might inhibit maladaptive plasticity in brain areas governing multidimensional functions, especially in sensorimotor- and cognition-related cortices.
Collapse
Affiliation(s)
- Bei-Bei Huo
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China
| | - Mou-Xiong Zheng
- Department of Traumatology and Orthopedics, Yueyang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China
| | - Xu-Yun Hua
- Department of Traumatology and Orthopedics, Yueyang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China
| | - Jun Shen
- Department of Orthopedic, Guanghua Hospital of Integrative Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China
| | - Jia-Jia Wu
- Department of Rehabilitation Medicine, Yueyang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China
| | - Jian-Guang Xu
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China
| |
Collapse
|
4
|
Vierck C. Mechanisms of Below-Level Pain Following Spinal Cord Injury (SCI). THE JOURNAL OF PAIN 2019; 21:262-280. [PMID: 31493490 DOI: 10.1016/j.jpain.2019.08.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 07/05/2019] [Accepted: 08/07/2019] [Indexed: 12/18/2022]
Abstract
Mechanisms of below-level pain are discoverable as neural adaptations rostral to spinal injury. Accordingly, the strategy of investigations summarized here has been to characterize behavioral and neural responses to below-level stimulation over time following selective lesions of spinal gray and/or white matter. Assessments of human pain and the pain sensitivity of humans and laboratory animals following spinal injury have revealed common disruptions of pain processing. Interruption of the spinothalamic pathway partially deafferents nocireceptive cerebral neurons, rendering them spontaneously active and hypersensitive to remaining inputs. The spontaneous activity among these neurons is disorganized and unlikely to generate pain. However, activation of these neurons by their remaining inputs can result in pain. Also, injury to spinal gray matter results in a cascade of secondary events, including excitotoxicity, with rostral propagation of excitatory influences that contribute to chronic pain. Establishment and maintenance of below-level pain results from combined influences of injured and spared axons in the spinal white matter and injured neurons in spinal gray matter on processing of nociception by hyperexcitable cerebral neurons that are partially deafferented. A model of spinal stenosis suggests that ischemic injury to the core spinal region can generate below-level pain. Additional questions are raised about demyelination, epileptic discharge, autonomic activation, prolonged activity of C nocireceptive neurons, and thalamocortical plasticity in the generation of below-level pain. PERSPECTIVE: An understanding of mechanisms can direct therapeutic approaches to prevent development of below-level pain or arrest it following spinal cord injury. Among the possibilities covered here are surgical and other means of attenuating gray matter excitotoxicity and ascending propagation of excitatory influences from spinal lesions to thalamocortical systems involved in pain encoding and arousal.
Collapse
Affiliation(s)
- Chuck Vierck
- Department of Neuroscience, University of Florida College of Medicine and McKnight Brain Institute, Gainesville, Florida.
| |
Collapse
|
5
|
Razak I, Chung TY, Ahmad TS. A Comparative Study of Two Modalities in Pain Management of Patients Presenting with Chronic Brachial Neuralgia. J Altern Complement Med 2019; 25:861-867. [PMID: 31211607 DOI: 10.1089/acm.2019.0052] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Objectives: The study aims to assess, evaluate, and compare the efficacy of acupressure and hypnotherapy in the management of pain in patients presenting with chronic brachial neuralgia (CBN). Design: Randomized controlled trial. Settings/location: Department of Orthopaedic Surgery, University Malaya Medical Centre, Kuala Lumpur, Malaysia. Subjects: Forty patients with CBN following traumatic brachial plexus injury from 2012 to 2017. Intervention: Therapy for a duration of 1 month in two groups; subjects in the hypnotherapy group received a weekly session of clinical hypnotherapy (total of four times) using a standardized protocol, while subjects in the acupressure group were guided by an acupuncturist during the initial session, received 2 month take home supply of acupressure patches, and were reviewed fortnightly. Outcome measures: The Visual Analog Scale, the Brief Pain Inventory, and the SF-36v2® Health Survey were recorded at different time points; 1 month pretreatment (week 0), pretreatment (week 4), post-treatment (week 8), and 4 months post-treatment (week 20). Results: There was a statistically significant improvement in the average pain intensity from pretreatment to post-treatment score in both groups. The pain intensity increased 4 months later; however, the pain intensity was still significantly reduced in comparison with pretreatment scores. The study suggests that both treatment outcomes are effective in terms of alleviating pain and improving quality of life in subjects with CBN, to a different degree. Conclusion: Overall, both therapies were able to improve the pain intensity and quality of life significantly during the treatment period. Hypnotherapy was observed to have a better carryover effect compared to acupressure, especially in terms of improving quality of life and the mental component score.
Collapse
Affiliation(s)
- Izzati Razak
- 1Department of Orthopaedic Surgery, Faculty of Medicine, National Orthopaedic Centre of Excellence for Research and Learning (NOCERAL), University of Malaya, Kuala Lumpur, Malaysia
| | - Tze Yang Chung
- 2Department of Rehabilitation Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - T Sara Ahmad
- 1Department of Orthopaedic Surgery, Faculty of Medicine, National Orthopaedic Centre of Excellence for Research and Learning (NOCERAL), University of Malaya, Kuala Lumpur, Malaysia
| |
Collapse
|
6
|
Meng C, Yang X, Liu Y, Zhou Y, Rui J, Li S, Xu C, Zhuang Y, Lao J, Zhao X. Decreased expression of lncRNA Malat1 in rat spinal cord contributes to neuropathic pain by increasing neuron excitability after brachial plexus avulsion. J Pain Res 2019; 12:1297-1310. [PMID: 31114309 PMCID: PMC6497903 DOI: 10.2147/jpr.s195117] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Accepted: 03/15/2019] [Indexed: 11/23/2022] Open
Abstract
Purpose: Neuropathic pain (NP) is a challenging clinical problem due to its complex pathogenesis. In our previous study using microarray, we found that the levels of lncRNA Malat1 were decreased in the spinal cord of NP rat after brachial plexus avulsion, but its contribution to NP remain unclear. The purpose of this study was to investigate its role in the pathogenesis of NP. Methods: In the NP model of complete brachial plexus avulsion rat, spinal cords were harvested, and fluorescence in situ hybridization (FISH) was used to test the spatial expression of Malat1 and qRT-PCR was used to confirm the quantitative expression of Malat1. In primary cultured neurons, Malat1 expression interfered with adenovirus. Spontaneous electric activities of neurons were tested using multi-electrode arrays and apoptosis of neurons was tested using TUNEL method. The change of intracellular calcium concentration was analyzed using calcium imaging method. Results: Decreased Malat1 expression was confirmed using qRT-PCR, and Malat1 was identified in the cytoplasm of neurons in spinal cord, but not in glia. In vitro, the decrease of Malat1 resulted in an increase in the frequency of spontaneous electric activity in neurons but had no effect on neuronal apoptosis. Further analysis indicated during glutamate stimulation, the change of intracellular calcium concentration in neurons with downregulated Malat1 expression was significantly greater than that in normal neurons. Conclusion: Reduced Malat1 expression may induce NP by increasing neuronal excitability in the spinal cord via regulation of calcium flux.
Collapse
Affiliation(s)
- Chong Meng
- Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai 200040, People's Republic of China.,Key Laboratory of Hand Reconstruction, Ministry of Health, Shanghai 200032, People's Republic of China.,Shanghai Key Laboratory of Peripheral Nerve and Microsurgery, Shanghai 200032, People's Republic of China
| | - Xun Yang
- Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai 200040, People's Republic of China.,Key Laboratory of Hand Reconstruction, Ministry of Health, Shanghai 200032, People's Republic of China.,Shanghai Key Laboratory of Peripheral Nerve and Microsurgery, Shanghai 200032, People's Republic of China
| | - Yuzhou Liu
- Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai 200040, People's Republic of China.,Key Laboratory of Hand Reconstruction, Ministry of Health, Shanghai 200032, People's Republic of China.,Shanghai Key Laboratory of Peripheral Nerve and Microsurgery, Shanghai 200032, People's Republic of China
| | - Yingjie Zhou
- Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai 200040, People's Republic of China.,Key Laboratory of Hand Reconstruction, Ministry of Health, Shanghai 200032, People's Republic of China.,Shanghai Key Laboratory of Peripheral Nerve and Microsurgery, Shanghai 200032, People's Republic of China
| | - Jing Rui
- Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai 200040, People's Republic of China.,Key Laboratory of Hand Reconstruction, Ministry of Health, Shanghai 200032, People's Republic of China.,Shanghai Key Laboratory of Peripheral Nerve and Microsurgery, Shanghai 200032, People's Republic of China
| | - Shenqian Li
- Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai 200040, People's Republic of China.,Key Laboratory of Hand Reconstruction, Ministry of Health, Shanghai 200032, People's Republic of China.,Shanghai Key Laboratory of Peripheral Nerve and Microsurgery, Shanghai 200032, People's Republic of China
| | - Ce Xu
- Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai 200040, People's Republic of China.,Key Laboratory of Hand Reconstruction, Ministry of Health, Shanghai 200032, People's Republic of China.,Shanghai Key Laboratory of Peripheral Nerve and Microsurgery, Shanghai 200032, People's Republic of China
| | - Yongqing Zhuang
- Hand Surgery Department, Shenzhen People's Hospital, Shenzhen 518020, People's Republic of China
| | - Jie Lao
- Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai 200040, People's Republic of China.,Key Laboratory of Hand Reconstruction, Ministry of Health, Shanghai 200032, People's Republic of China.,Shanghai Key Laboratory of Peripheral Nerve and Microsurgery, Shanghai 200032, People's Republic of China
| | - Xin Zhao
- Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai 200040, People's Republic of China.,Key Laboratory of Hand Reconstruction, Ministry of Health, Shanghai 200032, People's Republic of China.,Shanghai Key Laboratory of Peripheral Nerve and Microsurgery, Shanghai 200032, People's Republic of China
| |
Collapse
|
7
|
The Localization Research of Brain Plasticity Changes after Brachial Plexus Pain: Sensory Regions or Cognitive Regions? Neural Plast 2019; 2019:7381609. [PMID: 30728834 PMCID: PMC6341257 DOI: 10.1155/2019/7381609] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 10/30/2018] [Accepted: 11/19/2018] [Indexed: 01/08/2023] Open
Abstract
Objective Neuropathic pain after brachial plexus injury remains an increasingly prevalent and intractable disease due to inadequacy of satisfactory treatment strategies. A detailed mapping of cortical regions concerning the brain plasticity was the first step of therapeutic intervention. However, the specific mapping research of brachial plexus pain was limited. We aimed to provide some localization information about the brain plasticity changes after brachial plexus pain in this preliminary study. Methods 24 Sprague-Dawley rats received complete brachial plexus avulsion with neuropathic pain on the right forelimb successfully. Through functional imaging of both resting-state and block-design studies, we compared the amplitude of low-frequency fluctuations (ALFF) of premodeling and postmodeling groups and the changes of brain activation when applying sensory stimulation. Results The postmodeling group showed significant decreases on the mechanical withdrawal threshold (MWT) in the bilateral hindpaws and thermal withdrawal latency (TWL) in the left hindpaw than the premodeling group (P < 0.05). The amplitude of low-frequency fluctuations (ALFF) of the postmodeling group manifested increases in regions of the left anterodorsal hippocampus, left mesencephalic region, left dorsal midline thalamus, and so on. Decreased ALFF was observed in the bilateral entorhinal cortex compared to that of the premodeling group. The results of block-design scan showed significant differences in regions including the limbic/paralimbic system and somatosensory cortex. Conclusion We concluded that the entorhinal-hippocampus pathway, which was part of the Papez circuit, was involved in the functional integrated areas of brachial plexus pain processing. The regions in the “pain matrix” showed expected activation when applying instant nociceptive stimulus but remained silent in the resting status. This research confirmed the involvement of cognitive function, which brought novel information to the potential new therapy for brachial plexus pain.
Collapse
|
8
|
Shen J, Huo BB, Hua XY, Zheng MX, Lu YC, Wu JJ, Shan CL, Xu JG. Cerebral 18F-FDG metabolism alteration in a neuropathic pain model following brachial plexus avulsion: A PET/CT study in rats. Brain Res 2019; 1712:132-138. [PMID: 30738025 DOI: 10.1016/j.brainres.2019.02.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 02/03/2019] [Accepted: 02/05/2019] [Indexed: 12/14/2022]
Abstract
The present study aimed to investigate cerebral metabolic changes in a neuropathic pain model following deafferentation. A total of 24 Sprague-Dawley rats were included for modeling of right brachial plexus avulsion (BPA) through the posterior approach. As nerve injury would cause central sensitization and facilitate pain sensitivity in other parts of the body, thermal withdrawal latency (TWL) of the intact forepaw was assessed to investigate the level of pain perception following BPA-induced neuropathic pain. [Fluorine-18]-fluoro-2-deoxy-d-glucose (18F-FDG) positron emission tomography (PET) was applied to the brain before and after brachial plexus avulsion to explore metabolic changes in neuropathic pain following deafferentation. The TWL of the left (intact) forepaw was significantly lower after BPA than that of baseline (p < 0.001). Using TWL as a covariate, standardized uptake values (SUVs) of 18F-FDG significantly increased in the ipsilateral dorsolateral thalamus and contralateral anterodorsal hippocampus after BPA. Conversely, SUVs in multiple brain regions decreased, including the contralateral somatosensory cortex, ipsilateral cingulate cortex, and ipsilateral temporal association cortex. The Pearson correlation analysis showed that the SUVs of the contralateral anterodorsal hippocampus and ipsilateral dorsolateral thalamus were negatively related to the TWL of the intact forepaw, whereas the SUVs in the contralateral somatosensory cortex and ipsilateral cingulate cortex were positively related to it (p < 0.05). These findings indicate that upregulation of metabolism in the anterodorsal hippocampus and dorsolateral thalamus and downregulation metabolism in the contralateral somatosensory cortex and ipsilateral cingulate cortex could be a unique pattern of metabolic changes for neuropathic pain following brachial plexus avulsion.
Collapse
Affiliation(s)
- Jun Shen
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Bei-Bei Huo
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xu-Yun Hua
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China; Department of Trauma and Orthopedics, Yueyang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Mou-Xiong Zheng
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China; Department of Trauma and Orthopedics, Yueyang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Ye-Chen Lu
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Jia-Jia Wu
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Chun-Lei Shan
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China; Department of Rehabilitation Medicine, Yueyang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Jian-Guang Xu
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China; Department of Rehabilitation Medicine, Yueyang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China.
| |
Collapse
|
9
|
Ciaramitaro P, Padua L, Devigili G, Rota E, Tamburin S, Eleopra R, Cruccu G, Truini A. Prevalence of Neuropathic Pain in Patients with Traumatic Brachial Plexus Injury: A Multicenter Prospective Hospital-Based Study. PAIN MEDICINE 2018; 18:2428-2432. [PMID: 28340085 DOI: 10.1093/pm/pnw360] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Objective Prevalence and clinical characteristics of neuropathic pain due to traumatic brachial plexus injury. Design Observational epidemiological study. Setting Hospital-based multicenter study. Subjects One hundred seven prospectively enrolled patients with brachial plexus injury. Methods All the patients underwent clinical examination and neurophysiological testing for a definitive diagnosis of the brachial plexus lesion. The DN4 questionnaire was used to identify neuropathic pain, and the Neuropathic Pain Symptom Inventory (NPSI) to evaluate the different symptoms of neuropathic pain. The SF36 questionnaire and the Beck Depression Inventory (BDI) were used to assess quality of life and mood disturbances in patients with neuropathic pain. Results Of the 107 enrolled patients, 74 had pain (69%); neuropathic pain, as assessed by means of the DN4, was identified in 60 (56%) of these patients. According to the NPSI, the most frequent and severe pain type was the spontaneous burning pain. Clinical and neurophysiological findings showed that pain is unrelated to age but is associated with the severity of peripheral nerve damage. The SF36 questionnaire and BDI showed that neuropathic pain impairs quality of life and causes depression. Conclusions Our study provides information on the prevalence, characteristics, and variables associated with neuropathic pain due to traumatic brachial plexus injuries that might provide a basis for improving the clinical management of this condition.
Collapse
Affiliation(s)
- Palma Ciaramitaro
- Clinical Neurophysiology, Neuroscience Department, AOU Città della Salute e della Scienza di Torino, Torino, Italy
| | - Luca Padua
- Institute of Neurology, Catholic University, Rome, Italy.,Don Carlo Gnocchi Onlus Foundation, Italy
| | - Grazia Devigili
- AOU S. Maria della Misericordia, UOC Neurologia, Udine, Italy
| | - Eugenia Rota
- Presidio Ospedaliero di Piacenza, UOC Neurologia, Piacenza, Italy
| | - Stefano Tamburin
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Roberto Eleopra
- AOU S. Maria della Misericordia, UOC Neurologia, Udine, Italy
| | - Giorgio Cruccu
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Andrea Truini
- Department of Neurology and Psychiatry, Sapienza University, Rome, Italy
| | | |
Collapse
|
10
|
Emamhadi M, Andalib S. Nerve transfer to relieve pain in upper brachial plexus injuries: Does it work? Clin Neurol Neurosurg 2017; 163:67-70. [DOI: 10.1016/j.clineuro.2017.10.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Revised: 10/05/2017] [Accepted: 10/13/2017] [Indexed: 11/16/2022]
|
11
|
Roy HA, Green AL, Aziz TZ. State of the Art: Novel Applications for Deep Brain Stimulation. Neuromodulation 2017; 21:126-134. [DOI: 10.1111/ner.12604] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Revised: 02/19/2017] [Accepted: 03/11/2017] [Indexed: 02/06/2023]
Affiliation(s)
- Holly A. Roy
- Nuffield Department of Surgical Sciences; Oxford University; Oxford UK
- Neurosurgery Department; Oxford University Hospitals; Oxford UK
| | - Alexander L. Green
- Nuffield Department of Surgical Sciences; Oxford University; Oxford UK
- Neurosurgery Department; Oxford University Hospitals; Oxford UK
| | - Tipu Z. Aziz
- Nuffield Department of Surgical Sciences; Oxford University; Oxford UK
- Neurosurgery Department; Oxford University Hospitals; Oxford UK
| |
Collapse
|
12
|
Guo JR, Wang H, Jin XJ, Jia DL, Zhou X, Tao Q. Effect and mechanism of inhibition of PI3K/Akt/mTOR signal pathway on chronic neuropathic pain and spinal microglia in a rat model of chronic constriction injury. Oncotarget 2017; 8:52923-52934. [PMID: 28881783 PMCID: PMC5581082 DOI: 10.18632/oncotarget.17629] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Accepted: 01/03/2017] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE To explore the effects of inhibition of PI3K/Akt/mTOR signal pathway on chronic neuropathic pain (CNP) and spinal microglia in a rat model of chronic constriction injury (CCI). METHODS Male SD rats were assigned into control, sham, CCI, wortmannin, dimethyl sulfoxide (DMSO) and wortmannin-positive control groups. Paw withdrawal mechanical threshold (PWMT) and thermal withdrawal latency (TWL) were recorded. qRT-PCR and Western blotting were used to detect PI3K, Akt and mTOR expressions and their phosphorylation. OX-4 expression was detected by immunohistochemistry and glial fibrillary acidic protein (GFAP) and nerve growth factor (NGF) expressions by immunofluorescence. RESULTS PWMT and TWL decreased in the CCI group than in the sham group on the 7th and 14th day after operation. Compared with the control and sham groups, the CCI group showed increased PI3K, Akt and mTOR mRNA expressions and elevated PI3K, p-Akt, p-mTOR and P70S6K protein expressions. More OX-42-positive cells and higher integrated optical density (IOD) of GFAP and NGF were found in the CCI group than the sham group at the 14th day after operation. Compared with the DMSO group, the wortmannin group had higher PWMT and TWL, decreased PI3K, Akt and mTOR mRNA expressions and reduced PI3K, p-Akt, p-mTOR and P70S6K protein expressions. Less OX-42-positive cells and lower IOD of GFAP and NGF were found in the wortmannin group than the DMSO group 14th day after operation. CONCLUSION Inhibition of PI3K/Akt/mTOR signal pathway may alleviate CNP and reduce microglia and GFAP and NGF expressions in marrow in a rat model of CCI.
Collapse
Affiliation(s)
- Jian-Rong Guo
- Department of Anesthesiology, Gongli Hospital, Second Military Medical University, Shanghai 200135, P.R. China
| | - Huan Wang
- Department of Anesthesiology, Gongli Hospital, Second Military Medical University, Shanghai 200135, P.R. China
| | - Xiao-Ju Jin
- Department of Anesthesiology, Yijishan Hospital, Wannan Medical College, Wuhu 241001, P.R. China
| | - Dong-Lin Jia
- Pain Department, Peking University Third Hospital, Beijing, 100191, P.R. China
| | - Xun Zhou
- Department of Anesthesiology, Gongli Hospital, Second Military Medical University, Shanghai 200135, P.R. China
| | - Qiang Tao
- Department of Anesthesiology, Gongli Hospital, Second Military Medical University, Shanghai 200135, P.R. China
| |
Collapse
|
13
|
Kim JH, Shin SH, Lee YR, Lee HS, Chon JY, Sung CH, Hong SJ, Lee JY, Moon HS. Ultrasound-guided peripheral nerve stimulation for neuropathic pain after brachial plexus injury: two case reports. J Anesth 2017; 31:453-457. [PMID: 28190124 DOI: 10.1007/s00540-017-2315-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Accepted: 01/21/2017] [Indexed: 11/26/2022]
Abstract
Brachial plexus injury (BPI) often causes severe neuropathic pain that becomes chronic and difficult to treat pharmacologically or surgically. Here, we describe two cases of successful treatment of BPI with peripheral nerve stimulation (PNS). Both patients had experienced severe neuropathic pain after incomplete BPI for a long time (32 and 17 years) and did not response to medication, radiofrequency neuroablation, or spinal cord stimulation. After PNS using ultrasound, their pain was relieved by more than 50% over the course of 1 year. Both patients were satisfied with their improved sleep and quality of life. We conclude that PNS could be an alternative therapeutic modality for neuropathic pain after BPI as it provides direct nerve stimulation, has few complications, and is easy to perform.
Collapse
Affiliation(s)
- Jung Hyun Kim
- Gotbareun Intervention Pain Management Center, Seoul, Republic of Korea
| | - Sang Ho Shin
- Department of Anesthesiology and Pain Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 10, 63-ro, Yeoungdeungpo-gu, Seoul, 07345, Republic of Korea
| | - Young Rong Lee
- Department of Anesthesiology and Pain Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 10, 63-ro, Yeoungdeungpo-gu, Seoul, 07345, Republic of Korea
| | - Hyo Seon Lee
- Department of Anesthesiology and Pain Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 10, 63-ro, Yeoungdeungpo-gu, Seoul, 07345, Republic of Korea
| | - Jin Young Chon
- Department of Anesthesiology and Pain Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 10, 63-ro, Yeoungdeungpo-gu, Seoul, 07345, Republic of Korea
| | - Choon Ho Sung
- Department of Anesthesiology and Pain Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 10, 63-ro, Yeoungdeungpo-gu, Seoul, 07345, Republic of Korea
| | - Sung Jin Hong
- Department of Anesthesiology and Pain Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 10, 63-ro, Yeoungdeungpo-gu, Seoul, 07345, Republic of Korea
| | - Ji Young Lee
- Department of Anesthesiology and Pain Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 10, 63-ro, Yeoungdeungpo-gu, Seoul, 07345, Republic of Korea
| | - Ho Sik Moon
- Department of Anesthesiology and Pain Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 10, 63-ro, Yeoungdeungpo-gu, Seoul, 07345, Republic of Korea.
| |
Collapse
|
14
|
Subedi A, Chaudakshetrin P, Chotisukarat H, Mandee S. Effect of Co-Morbid Conditions on Persistent Neuropathic Pain after Brachial Plexus Injury in Adult Patients. J Clin Neurol 2016; 12:489-494. [PMID: 27819420 PMCID: PMC5063877 DOI: 10.3988/jcn.2016.12.4.489] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Revised: 05/05/2016] [Accepted: 05/09/2016] [Indexed: 02/06/2023] Open
Abstract
Background and Purpose Neuropathic pain (NeuP) associated with traumatic brachial plexus injury (BPI) can be severe, persistent, and resistant to treatment. Moreover, comorbidity associated with NeuP may worsen the pain and quality of life. This study compared persistent NeuP after BPI between patients with and without co-morbid conditions (psychiatric dysfunction and other painful conditions) and tramadol usage as a second-line agent in combination with an antiepileptic and/or antidepressant during a 2-year follow-up. Methods The medical records of patients diagnosed with BPI referred to a pain center between 2006 and 2010 were reviewed for 2 years retrospectively. Data regarding patient demographics, injury and surgical profiles, characteristics of NeuP and its severity, and treatment received were compared between patients with and without manifesting co-morbid conditions. The NeuP and pain intensity assessments were based on the DN4 questionnaire and a numerical rating scale, respectively. Results Of the 45 patients studied, 24 patients presented with one of the following co-morbid conditions: myofascial pain (21%), psychiatric disorder (17%), phantom limb pain (4%), complex regional pain syndrome (21%), and insomnia (37%). Tramadol was required by 20 patients with co-morbidity and, 9 patients without co-morbidity (p<0.001). The mean pain score after 2 years was higher in patients with co-morbidity than in those without co-morbidity (p<0.05). Conclusions Persistent pain following BPI was more common in patients manifesting other painful conditions or psychiatric co-morbidity. A higher proportion of the patients in the co-morbid group required tramadol as a second-line of agent for pain relief.
Collapse
Affiliation(s)
- Asish Subedi
- Department of Anesthesiology, BPKIHS, Dharan, Nepal.
| | | | | | - Sahatsa Mandee
- Department of Anesthesiology, Siriraj Hospital, Bangkok, Thailand
| |
Collapse
|
15
|
Attenuation of brain grey matter volume in brachial plexus injury patients. Neurol Sci 2015; 37:51-56. [PMID: 26255300 DOI: 10.1007/s10072-015-2356-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2015] [Accepted: 07/30/2015] [Indexed: 10/23/2022]
Abstract
Brachial plexus injury (BPI) causes functional changes in the brain, but the structural changes resulting from BPI remain unknown. In this study, we compared grey matter volume between nine BPI patients and ten healthy controls by means of voxel-based morphometry. This was the first study of cortical morphology in BPI. We found that brain regions including the cerebellum, anterior cingulate cortex, bilateral inferior, medial, superior frontal lobe, and bilateral insula had less grey matter in BPI patients. Most of the affected brain regions of BPI patients are closely related to motor function. We speculate that the loss of grey matter in multiple regions might be the neural basis of the difficulties in the motor rehabilitation of BPI patients. The mapping result might provide new target regions for interventions of motor rehabilitation.
Collapse
|