European journal of pain : EJP
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Temporomandibular disorders represent one of the major challenges in dentistry therapeutics. This study was undertaken to evaluate the time course of carrageenan-induced inflammation in the rat temporomandibular joint (TMJ) and to investigate the role of tachykinin NK(1) receptors. Inflammation was induced by a single intra-articular (i.art.) injection of carrageenan into the left TMJ (control group received sterile saline). ⋯ Treatment with SR140333 substantially inhibited the increase in plasma extravasation and leukocyte influx at 4 and 24h, as well as the production of TNFalpha and IL-1beta into the joint cavity, but failed to affect changes in head-withdrawal threshold. The results obtained from the present TMJ-arthritis model provide, for the first time, information regarding the time course of this experimental inflammatory process. In addition, our data show that peripheral NK(1) receptors mediate the production of both TNFalpha and IL-1beta in the TMJ as well as some of the inflammatory signs, such as plasma extravasation and leukocyte influx, but not the nociceptive component.
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Comparative Study
Painful or painless lower limb dysesthesias are highly predictive of peripheral neuropathy: comparison of different diagnostic modalities.
Dysesthesias of the lower limbs are a common complaint of patients and may be indicative of peripheral neuropathy. Here we investigated the prevalence and type of neuropathy in patients presenting with this complaint and compared the diagnostic performance of different diagnostic modalities. Forty-two patients were recruited prospectively and underwent a clinical examination, nerve conduction studies, quantitative sensory testing (QST), and skin biopsy at the dorsum of the foot. ⋯ Decreased intraepidermal nerve fiber density (IENFD) was found in 37 patients (88.1%), including some patients with normal QST findings. Nearly all patients with pathological QST had a reduced IENFD, indicating a high positive predictive value (93%) of QST in screening for reduced IENFD as correlate for neuropathy. Therefore in all patients with lower limb dysesthesias of unknown origin, the non-invasive methods of NCS and QST should be used and potentially complemented by skin biopsy.
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Cutaneous C-fiber afferents show two distinct types of cold sensitivity corresponding to non-noxious and noxious cold sensations. Here, responses to cold stimulation of afferent fibers regenerating in the rat sural nerve were studied in vivo 7-14 days after nerve crush and compared with responses to mechanical and heat stimulation. The physiological stimuli were applied to the sural nerve at or distal to the lesion site. ⋯ They were also heat-sensitive (n=25) and/or mechanosensitive (n=20). These C-fibers were, apart from their cold sensitivity, functionally indistinguishable from C-fibers with mechano- and/or heat sensitivity only. Thus regenerating cutaneous C-fibers show two types of cold sensitivity similar to those observed in intact skin: fibers of one group are predominantly sensitive to cooling, whereas the others are polymodal.
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Randomized Controlled Trial Comparative Study
Gastrointestinal symptoms under opioid therapy: a prospective comparison of oral sustained-release hydromorphone, transdermal fentanyl, and transdermal buprenorphine.
The purpose of this trial was to evaluate the effect of long-term treatment with oral sustained-release hydromorphone, transdermal fentanyl, and transdermal buprenorphine on nausea, emesis and constipation. ⋯ Gastrointestinal symptoms of cancer pain patients undergoing an opioid therapy are related to multifactorial causes. Transdermal opioids showed no benefit over oral controlled-release hydromorphone with regard to gastrointestinal symptoms. The conversion ratios for transdermal fentanyl, transdermal buprenorphine, and oral hydromorphone did not accord to the literature, because of differing occurrences of opioid tolerance after long-term therapy.