Seminars in Pain Medicine最新文献_第6页

Catheter tip-associated granuloma: inflammatory mass with intrathecal drug delivery 导管尖端相关肉芽肿:伴有鞘内药物输送的炎性肿块

Seminars in Pain Medicine Pub Date : 2004-03-01 DOI: 10.1016/j.spmd.2003.10.004

Timothy R Deer MD, DABPM

{"title":"Catheter tip-associated granuloma: inflammatory mass with intrathecal drug delivery","authors":"Timothy R Deer MD, DABPM","doi":"10.1016/j.spmd.2003.10.004","DOIUrl":"10.1016/j.spmd.2003.10.004","url":null,"abstract":"<div>Use of the intrathecal route to deliver drugs has become an acceptable treatment method for difficult pain syndromes. The primary advantage of intrathecal administration is the ability to deliver adequate relief at substantially lower doses of medication compared with other routes. This reduction of drug dosing leads to fewer side effects and improved efficacy. Morphine sulfate has been the most commonly used drug although other opioids and nonopioids have been prescribed. Over the past decade, the complication of an inflammatory mass at the catheter tip has been described. The prevalence of this problem appears to be much lower than 1%; however, because of the potential hazards, diagnostic vigilance is critical. Patient evaluation and reevaluation are the most important part aspect of the diagnosis. Loss of clinical efficacy, dermatomal pain in the distribution of the catheter tip, proprioceptive change, and sensory loss are early warnings. Motor loss, bladder and bowel dysfunction, and paralysis are late findings and occur with progression. When suspicion of the complication arises, a plain film should be obtained to identify the catheter tip, and then a T1-weighted image should be performed at the tip. When magnetic resonance imaging (MRI) is not possible, a computerized tomography (CT) myelogram is an acceptable alternative. Treatment of this lesion involves discontinuing the infusion, then revising or removing the catheter. If spinal cord compression occurs, the treatment is direct surgical decompression. Many patients have continued with treatment after an inflammatory mass is diagnosed, once the catheter is revised or replaced. Prevention includes change of medications, avoidance of high-concentration morphine and hydromorphone, change of catheter tip location, and use of multiorifice catheters.</div>","PeriodicalId":101158,"journal":{"name":"Seminars in Pain Medicine","volume":"2 1","pages":"Pages 21-26"},"PeriodicalIF":0.0,"publicationDate":"2004-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.spmd.2003.10.004","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75028020","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 4

Interaction between sex and genotype in the mediation of pain and pain inhibition 性别和基因型在疼痛和疼痛抑制中介中的相互作用

Seminars in Pain Medicine Pub Date : 2003-12-01 DOI: 10.1016/S1537-5897(03)00028-4

Jeffrey S Mogil PhD

引用次数: 12

Intraspinal drug delivery routes for treatment of chronic pain and spasticity 治疗慢性疼痛和痉挛的椎管内给药途径

Seminars in Pain Medicine Pub Date : 2003-12-01 DOI: 10.1016/j.spmd.2004.01.001

Leonardo Kapural MD, PhD , Alexandra Szabova MD , Nagy A Mekhail MD, PhD

引用次数: 3

Protein kinase c ϵ and γ: roles in age-specific modulation of acute opioid-withdrawal allodynia 蛋白激酶c ε和γ:急性阿片类戒断异常性疼痛的年龄特异性调节作用

Seminars in Pain Medicine Pub Date : 2003-12-01 DOI: 10.1016/S1537-5897(03)00027-2

Sarah M Sweitzer PhD , Jennifer A Shumilla PhD , Maurice H Zissen , Joan J Kendig PhD

{"title":"Protein kinase c ϵ and γ: roles in age-specific modulation of acute opioid-withdrawal allodynia","authors":"Sarah M Sweitzer PhD , Jennifer A Shumilla PhD , Maurice H Zissen , Joan J Kendig PhD","doi":"10.1016/S1537-5897(03)00027-2","DOIUrl":"10.1016/S1537-5897(03)00027-2","url":null,"abstract":"<div>Acute morphine withdrawal results in enhanced responsiveness to noxious stimulation in adult humans and rodents. This study extends these findings by demonstrating that acute morphine withdrawal produces allodynia in neonatal rats that is dependent on the translocation of protein kinase C ϵ and γ (ϵPKC and γPKC, respectively) in a developmentally specific manner. Basal expression of ϵPKC in dorsal root ganglia, and γPKC in lamina II of the lumbar spinal cord, were lower in postnatal day 7 (P7) compared with P21 rats. ϵPKC immunoreactivity increased in P7 rats at 4 hours after acute administration of morphine, whereas ϵPKC immunoreactivity decreased at 4 hours in P21 rats. In contrast to ϵPKC, there was a loss of γPKC immunoreactivity following morphine administration in both P7 and P21 rats. To determine whether ϵ and γPKC contribute to acute withdrawal-induced allodynia in neonatal rats, isozyme-specific inhibitors of ϵ and γPKC translocation were administered before or after morphine administration. Naloxone was used to precipitate withdrawal at either 30 or 120 minutes after morphine, or animals were allowed to undergo natural withdrawal from a single dose of morphine. Inhibition of ϵ but not γPKC prevented naloxone-precipitated allodynia 30 minutes after morphine administration in P7 rats. In contrast, both ϵ and γPKC inhibitors attenuated naloxone-precipitated allodynia in P21 rats. Allodynia was attenuated in P7 and P21 rats by administration of either ϵ or γPKC inhibitor when withdrawal was precipitated at 2 hours after morphine or animals underwent natural withdrawal. This work demonstrates that the role of ϵ and γPKC in acute withdrawal-induced allodynia is developmentally regulated in a temporally specific manner.</div>","PeriodicalId":101158,"journal":{"name":"Seminars in Pain Medicine","volume":"1 4","pages":"Pages 206-219"},"PeriodicalIF":0.0,"publicationDate":"2003-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1537-5897(03)00027-2","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88421879","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 3

Intraspinal drug delivery for chronic pain and spasticity: anatomic and physiologic considerations 慢性疼痛和痉挛的椎管内给药:解剖学和生理学的考虑

Seminars in Pain Medicine Pub Date : 2003-12-01 DOI: 10.1016/j.spmd.2004.02.005

Sami Moufawad MD , Nagy A Mekhail MD, PhD

引用次数: 0

Future topics 未来的主题

Seminars in Pain Medicine Pub Date : 2003-12-01 DOI: 10.1016/S1537-5897(04)00016-3

引用次数: 0

Gene-based therapy for treatment of chronic pain 基因疗法治疗慢性疼痛

Seminars in Pain Medicine Pub Date : 2003-12-01 DOI: 10.1016/S1537-5897(03)00029-6

Steven P Wilson PhD

{"title":"Gene-based therapy for treatment of chronic pain","authors":"Steven P Wilson PhD","doi":"10.1016/S1537-5897(03)00029-6","DOIUrl":"10.1016/S1537-5897(03)00029-6","url":null,"abstract":"<div>Two basic approaches have been employed in experiments designed to test potential gene-based therapies for chronic pain in humans. First, local or spinal overexpression of neuropeptides, growth factors, and biosynthetic enzymes for neurotransmitters in non-neuronal cells has been tested in animals. Continued production and release of these antinociceptive proteins into the cerebrospinal fluid is analogous to intrathecal infusion of antinociceptive drugs. Second, overexpression of transgenes or knockdown of endogenous gene expression in primary or secondary neurons involved in nociception has been used in animal studies. Altered expression of neuropeptides, growth factors, enzymes, ion channels, or receptors in these nociceptive neurons can modulate pain transmission in an anatomically restricted, circuit-specific, and stimulation-dependent manner. Techniques employed in testing potential gene-based therapy for chronic pain include implantation of engineered cell lines, administration of antisense oligonucleotides or plasmids, and the use of viral vectors. Of the modalities tested to date, only intrathecal transplantation of engineered cells secreting antinociceptive gene products and delivery of therapeutic transgenes by herpes vectors demonstrate sufficient duration of expression to be useful for therapy of chronic pain.</div>","PeriodicalId":101158,"journal":{"name":"Seminars in Pain Medicine","volume":"1 4","pages":"Pages 220-226"},"PeriodicalIF":0.0,"publicationDate":"2003-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1537-5897(03)00029-6","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73839635","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 1

Pharmacology of intrathecally administered agents for treatment of spasticity and pain 鞘内给药治疗痉挛和疼痛的药理学

Seminars in Pain Medicine Pub Date : 2003-12-01 DOI: 10.1016/j.spmd.2004.02.002

Salim Michel Hayek MD, PhD , Pushpa Nambi Joseph MD , Nagy A Mekhail MD, PhD

引用次数: 16

Intrathecal drug therapy: general considerations 鞘内药物治疗:一般注意事项

Seminars in Pain Medicine Pub Date : 2003-12-01 DOI: 10.1016/j.spmd.2004.02.004

Jaroslaw S Przybyl MD , Kenneth A Follett MD, PhD , David Caraway MD, PhD

引用次数: 5

Genetics of pain therapy: one size does not fit all 疼痛治疗的遗传学:一种方法不适合所有人

Seminars in Pain Medicine Pub Date : 2003-12-01 DOI: 10.1016/j.spmd.2004.03.001

David C Yeomans PhD (Guest Editor)

引用次数: 0