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Transcranial direct current stimulation (tDCS) is used for various chronic pain conditions, but experience with tDCS for acute postoperative pain is limited. This study investigated the effect of tDCS vs. sham stimulation on postoperative morphine consumption and pain intensity after thoracotomy.
Learn More >We conducted a feasibility 2×2 factorial trial comparing N-methyl-D-aspartate (NMDA) antagonists (intravenous ketamine and oral memantine) versus placebo and intravenous steroids versus placebo, in patients having elective video-assisted thoracic surgery lobectomies, at St. Joseph's Hamilton, Canada, and Cleveland Clinic, Cleveland, USA. Our feasibility objectives were: 1) recruitment rate/week; 2) recruitment of ≥90% of eligible patients; and 3) >90% follow-up. Secondary objectives were incidence and intensity of persistent post-surgical pain (PPSP) and other clinical and safety outcomes.
Learn More >Osteoarthritis is the most prominent form of arthritis, affecting approximately 15% of the population in the United States. Knee osteoarthritis (KOA) has become one of the leading causes of disability in older adults. Besides knee replacement, there are no curative treatments for KOA, so persistent pain is commonly treated with opioids, acetaminophen, and nonsteroidal anti-inflammatory drugs. However, these drugs have many unpleasant side effects, so there is a need for alternative forms of pain management. We sought to test the efficacy of a dietary intervention to reduce KOA.
Learn More >Tumor-related cancer pain often comprises mixed pain with both nociceptive and neuropathic components. Whether tumor-related cancer pain includes a neuropathic component impacts the therapeutic strategy. The aim of this cross-sectional study was to investigate the usefulness of two screening tools for neuropathic pain, painDETECT and Self-Report Leeds Assessment of Neuropathic Symptoms and Signs (S-LANSS), in identifying the neuropathic component of mixed pain among patients with tumor-related cancer pain.
Learn More >Relief of cancer-related pain remains challenging despite the availability of a range of opioid and non-opioid medications. Animal models demonstrate that T lymphocytes may mediate analgesia by producing endogenous opioids, but definitive clinical data are limited. Adoptive transfer of ex vivo activated T cell products (ACT) is being tested as an anti-cancer therapy. We retrospectively reviewed the medical charts of 357 patients with various malignancies who received three intravenous infusions of autologous cytokine-activated T cell-enriched products. Among these were fifty-five (55) patients who required opioids for moderate or severe cancer-related pain. Opioid dosage and cancer pain score were recorded daily for 2 consecutive weeks prior to and 2 weeks after the ACT infusions. The average oral morphine equivalent doses (OMED) and cancer pain scores were significantly decreased following the ACT infusions. The proportion of patients with breakthrough pain also declined. Moreover, higher frequencies of expanded CD3+, CD3+/CD4+, and CD3+/CD8+ T cells within the ACT product were associated with favorable analgesic effects. Transient elevations in CD3+ and CD3+/CD8+ T cell subpopulations and decreases in CD4CD25 Treg were observed in patients' blood after the ACT. In conclusion, ACT was capable of reducing cancer pain severity and opioid consumption and favorably modulating peripheral blood T cell populations.
Learn More >Brain derived neurotrophic factor (BDNF) and the high affinity receptor tropomyosin receptor kinase B (TrkB) have important roles in neuronal survival and in spinal sensitization mechanisms associated with chronic pain. Recent clinical evidence also supports a peripheral role of BDNF in osteoarthritis (OA), with synovial expression of TrkB associated with higher OA pain. The aim of this study was to use clinical samples and animal models to explore the potential contribution of knee joint BDNF / TrkB signalling to chronic OA pain.BDNF and TrkB mRNA and protein were present in knee synovia from OA patients (16 women, 14 men, median age 67 [IQR: 61 – 73]). There was a significant positive correlation between mRNA expression of NTRK2 (TrkB) and the pro-inflammatory chemokine fractalkine in the OA synovia.Using the surgical medial meniscal transection (MNX) model and the chemical monosodium iodoacetate (MIA) model of OA pain in male rats, the effects of peripheral BDNF injection, versus sequestering endogenous BDNF with TrkB-Fc chimera, on established pain behaviour were determined. Intra-articular injection of BDNF augmented established OA pain behaviour in MIA rats, but had no effect in controls. Intra-articular injection of the TrkB-Fc chimera acutely reversed pain behaviour to a similar extent in both models of OA pain (weight-bearing asymmetry MIA: -11±4%, MNX: -12±4%), compared to vehicle treatment. Our data suggesting a contribution of peripheral knee joint BDNF / TrkB signalling in the maintenance of chronic OA joint pain support further investigation of the therapeutic potential of this target.
Learn More >Opioids and non-steroidal anti-inflammatory drugs (NSAIDs) are frequently prescribed for chronic musculoskeletal pain, despite limited evidence of effectiveness and well-documented adverse effects. We assessed the effects of participating in a structured, personalized self-experiment ("N-of-1 trial") on analgesic prescribing in patients with chronic musculoskeletal pain.
Learn More >Nemolizumab targets the interleukin 31 receptor alpha subunit (IL-31RA) involved in atopic dermatitis (AD) pathogenesis.
Learn More >Cohort/psychometric study OBJECTIVES: The primary objective was to determine the psychometric properties and the utility of the Neuropathic Pain Symptom Inventory (NPSI) in subgrouping people with moderate to severe neuropathic pain after spinal cord injury (SCI).
Learn More >Chronic inflammatory demyelinating polyneuropathy (CIDP) causes weakness which adversely impacts function and quality of life (QOL). CIDP often requires long-term management with intravenous or subcutaneous immunoglobulin. The Polyneuropathy and Treatment with Hizentra (PATH) study showed subcutaneous immunoglobulin (SCIG) was efficacious in CIDP maintenance. Here, we assess patient-reported outcomes in patients on SCIG.
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