Brain and nerve = Shinkei kenkyū no shinpo
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Pain is a common reason for seeking health care and chronic pain is a common comorbidity in psychiatric disorders. In clinical practice, we encounter many patients with chronic pain; however, before initiating pain treatment, we should conduct detailed analysis of psychiatric symptoms, such as perception, memory, thought and mood disturbances or behavioral problems. We should also determine the frequency of occurrence of mental disorders in patients with pain, especially those with chronic pain, such as in mood, anxiety, pain, personality, and developmental disorders, and dementia. Current understanding of the intricate relationship between chronic pain and psychiatric issues not only provides opportunities for designing appropriate treatment but also raises good and new questions for future pain research.
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Detection of unmyelinated epidermal nerve fibers allows objective, pathologic, and minimally invasive assessment of small myelinated A-delta and unmyelinated C primary afferent fibers. This procedure is especially valuable for diagnosing small fiber neuropathy; this condition is characterized by sensory symptoms and pain in the lower extremities but standard nerve conduction fails to show abnormalities in this condition. ⋯ In this review, we discuss standard technical aspects of skin biopsy introduced for evaluation of epidermal nerve fibers and the feasibility of skin biopsy for diagnosing small fiber neuropathy and neuronopathy. We also describe the usefulness of skin biopsy in diagnosing peripheral neuropathies and other neurological disorders.
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Review
[Pathophysiology of neuropathic pain: Na⁺ channel and hyperexcitability of primary afferents].
Neuropathic pain occurs as a result of peripheral neuropathy or peripheral nerve injury. Voltage-gated Na⁺ channels are assumed to play a major role in the pathophysiology of neuropathic pain and have become important therapeutic targets, because they are critical determinants of the excitability of sensory neurons. Nerve injury or disease could induce changes in trafficking, gene expression, and kinetics of Na⁺ channels, resulting in ectopic discharge and increased neuronal excitability. ⋯ Na⁺ channels are attractive targets for studying the pathophysiology of neuropathic pain and for drug development. However, recent advances have been mostly based on basic research. Overcoming the challenges in directly approaching patients with neuropathic pain might advance our understanding of the pathophysiology of pain and aid the development of therapeutic strategies.
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Musculoskeletal disorders are the most common causes of severe long-term pain and physical disability, affecting hundreds of millions of people around the world. In industrialized countries, which have increasingly aging populations, chronic musculoskeletal pain has become a significant health care burden and major issue in the 1980s and 1990s. On January 13, 2000, The Bone and Joint Decade was formally launched at the headquarters of the World Health Organization in Geneva, Switzerland. ⋯ Chronic pain had a significant impact on the occupational and social relationships, and it seriously affected their psychological conditions and quality of life. Such disabling chronic pain is regarded as the result of interrelated physical, psychological, and social or occupational factors requiring multidisciplinary intervention. We introduce a multidisciplinary clinical approach and report on novel multimodal methodologies -- for patients with chronic musculoskeletal pain.
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Different surgical procedures are available for the treatment of many neuropathic pain syndromes. These surgical procedures can be divided into 2 main sections: non-destructive and destructive procedures. In recent years, the non-destructive neurostimulation method has undergone rapid development. ⋯ Currently, destructive surgical procedures have a limited range of indications for pain control. However, the advantages of destructive procedures over non-destructive ones include continuous pain reduction without implantation of a stimulation system. Each of the surgical procedures has great potential for providing patients with significant relief from neuropathic pain.