Rejected

Recently, microRNAs are reported to be participated in the development of pain and persistence of neuropathic and inflammatory pain in animal models. Here, we characterized the functional role of miR-129-5p in pain processing in chronic constriction injury (CCI) rat models. Bilateral CCI operation was used to generate neuropathic pain rat model. Paw withdrawal threshold (PWT) and paw withdrawal latency (PWL) were used to assess pain-related behaviors. Gene expression was evaluated using qRT-PCR, luciferase assay, western blotting, and enzyme-linked immunosorbent assay. Compared with the control rats, expression level of miR-129-5p was downregulated significantly over time in CCI rats post operation. Interestingly, downregulation of miR-129-5p in CCI rats was correlated with increased proinflammatory cytokine expression and pain-related behaviors. Furthermore, we found that miR-129-5p alleviated neuropathic pain through downregulating high mobility group protein B1 (HMGB1) expression in CCI rats as overexpression of miR-129-5p suppressed expression of both HMGB1 and proinflammatory cytokine and alleviated pain sensation in CCI rats. In summary, our results show that alteration in miR-129-5p expression contributes to pain processing in our CCI pain rat model, suggesting miR-129-5p could be a causal factor in neuropathic pain and serve as a promising potential biomarker and therapeutic target for neuropathic pain.

Spontaneous splenic rupture is an atraumatic event that represents a rare and life-threatening acute complication in which the spleen is damaged producing internal hemorrhage in the abdominal cavity. Its association with hematologic malignancies, although a rare occurrence, has been previously described. Among this subset of patients, chronic myeloid leukemia is one of the main causes.

Patients with head and neck cancer represent a vulnerable population at particular risk of opioid dependence due to frequent histories of substance abuse, requirement of extensive surgery, and the synergistic toxicity of multimodal therapy. Regional anesthetic techniques have been used by other surgical disciplines to facilitate early recovery after surgery and decrease postoperative patient narcotic requirements. This pilot study investigates the efficacy of a preoperative regional analgesia using stellate ganglion block in lateralized head and neck cancer surgery. From our early results, stellate ganglion blockade may hold promise as an effective preoperative intervention for controlling early postoperative pain, lessening narcotic requirements, and improving quality of life.

A two-incision technique, in association with inter-muscular positioning of the subcutaneous defibrillator (S-ICD), is now the most frequently adopted implantation approach in Europe. Ultrasound-guided serratus anterior plane block (SAPB) has been proposed in order to provide anesthesia/analgesia during S-ICD implantation.

Schwann cells (SCs) have long been recognized for their ability to support repair and promote axon regeneration following injury to the peripheral nervous system. In response to nerve injury they rapidly dedifferentiate into a precursor-like state, secrete an array of inflammatory mediators and growth-factors, proliferate, undergo epithelial-to-mesenchymal-like transformation to facilitate migration, phagocytose cellular debris, and remodel the extracellular environment to promote regeneration of axons through the site of injury. However, even though a cutaneous role for SCs is becoming increasingly recognized, we argue in this Viewpoint essay that the likely complex functions of SCs in skin physiology and pathology beyond skin sensation and nerve repair deserves more attention and systemic research than they have received so far. For example, SCs promote wound healing, disseminate infection in leprosy, support the growth of neurofibromas/schwannomas, and facilitate/accelerate the growth and invasion of melanoma. Despite representing a major dermal cell population, comparatively little is still known about the role of SCs in other dermatoses. To quintessentially illustrate the opportunities that promise to arise from a new skin research focus on SCs, we focus on two dermatoses that are not traditionally associated with SCs, i.e. psoriasis and atopic dermatitis (AD), since both show distinct SC changes along with continuous nerve fiber degeneration and regeneration, and an impact of denervation on skin lesions. Specifically, we critically discuss the hypothesis that repeated activation of the SC repair program occurs in and contributes to psoriasis and AD and delineate experimental approaches how to probe this clinically relevant hypothesis.

Burning mouth syndrome (BMS) is a chronic intraoral burning sensation with no identifiable causes. In this study, we aim to demonstrate the effectiveness of treatment strategy using ethyl loflazepate monotherapy or in combination with milnacipran or amitriptyline.

Dental pain is the most common acute pain presenting in the orofacial region; however, chronic pain conditions are also frequent and include; temporomandibular joint disorders (TMDs), primary headaches (neurovascular pain), painful post-traumatic trigeminal neuropathy (PPTTN) and less commonly referred pain and idiopathic or centralized pain conditions. All of these conditions can mimic toothache and vice versa. Many of these conditions are comorbid with high levels of tension headache and migraine reported in patients with TMD; however, dentists remain unfamiliar with headaches and medics unfamiliar with toothache's multiple presentations. The anatomical complexity of the region, the potential exhaustive differential diagnoses and the multiple siloed training of specialties, leads to incorrect and delayed diagnosis and often results in patients undergoing inappropriate surgical and medical treatments. The continued inappropriate interventions may also complicate the later presentation of the patient with pain, by changing its phenotype, preventing a timely and correct diagnosis. Due to the variable presentation of toothache, which can mimic many different chronic pains including; episodic throbbing pain of migraine, the dull continuous pain of myofascial and arthrogenous TMDs or centralized facial pain, diagnosis can be complex. Neuralgic pain occurs in the dentition in health and with disease, mimicking conditions like PPTTN, trigeminal neuralgia (TN), and trigeminal autonomic cephalalgias (TACs), many patients are inappropriately diagnosed and treated, either by general medical practitioners assuming that the neuralgia is due to TN rather than more commonly presenting toothache or by a dentists or other surgeons continuing to treat TN or TACs with routine surgical care. Many patients are prescribed countless courses of antibiotics and undergo multiple surgical interventions simply as a result of poor education due to siloed specialty training. This must be addressed to improve patient safety.

Prerequisite opioid withdrawal symptoms prior to buprenorphine induction are unacceptable to many patients. We assessed whether transdermal buprenorphine minimized withdrawal while bridging to sublingual therapy among hospital inpatients.

Spinal cord stimulation (SCS) has gained traction as an alternative to chronic opioid therapy in light of the opioid crisis. Prior reports vary widely in their estimates of its effect on opioid consumption. We therefore aimed to address the following questions: 1) Does chronic opioid use change after SCS? 2) Which patient characteristics predict reduced opioid consumption after SCS?

Extracorporeal shockwave lithotripsy (ESWL) is widely used for the treatment of urinary tract calculi; however, the vast majority of the patients does not tolerate the procedure without analgesia and sedation. Pain control in ESWL has been crucial for process success and patient comfort. Systemic drugs, such as non-steroid anti-inflammatory drugs, opioids, alfa-2 agonist and various local and regional anesthesia methods (transversus abdominis plane block, paravertebral block, infiltration) have been applied to control ESWL pain. Quadratus lumborum block (QLB) is performed as one of the regional anesthetic techniques for abdominal surgery. This block provides anesthesia and analgesia on the anterior and lateral wall of the abdomen. In this report, we presented the analgesic efficacy of QLB in 15 patients, which included nine renal and six ureter stones for ESWL. The mean of the VAS scores ranged from 0.20±0.41 to 2.73±1.22, and mean fentanyl consumption was 15.00±15.08 mcg during the procedure. No opioid-related side effects were observed in any of the patients. Full fragmentation was obtained in nine of the 15 patients, and partial fragmentation was obtained in five patients.