Pain practice : the official journal of World Institute of Pain
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The mu-opioid receptor (OPRM1) A118G polymorphism has been associated with decreased analgesic effects of opioids and predisposition to addiction. However, its role in specific clinical scenarios and in different ethnicities must be better defined. No studies evaluating the A118G polymorphism in the Brazilian population have yet been published. ⋯ We developed a fast and reliable genotyping method to identify the allele frequency distribution of the OPRM1 A118G polymorphism among patients from Center-West Brazil. Our preliminary results suggest functional consequences of the polymorphism on smoking behavior among Brazilians.
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Clinical Trial
Anti tumor Necrosis Factor - Alpha Adalimumab for Complex Regional Pain Syndrome Type 1 (CRPS-I): A Case Series.
Evidence suggests tumor necrosis factor-alpha (TNF-α) mediates, at least in part, symptoms and signs in complex regional pain syndrome (CRPS). Here, we present a case series of patients with CRPS type 1, in whom the response to the anti-TNF-α adalimumab was assessed. ⋯ These results suggest adalimumab, and possibly other anti-TNF-α, can be potentially useful in some (although not in all) patients with CRPS type 1. These preliminary results along with the growing body of evidence which points to the involvement of TNF-α in the pathogenesis of CRPS justify further studies in this area.
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There is convincing evidence that inflammation plays a pivotal role in the pathophysiology of complex regional pain syndrome (CRPS). Besides inflammation, central sensitization is also an important phenomenon. ⋯ In the development of a more mechanism-based treatment, influencing the activity of mast cells might be important in the treatment of CRPS. We describe the rationale for using medication that counteracts the effects of mast cells in the treatment of CRPS.
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Cytokines and oxygen free radicals have been implicated in the potential pathogenic development of complex regional pain syndrome (CRPS). We aimed to analyze the relationship between clinical status, circulating levels of cytokines, and markers of oxidative damage during the treatment with anti-TNFα antibodies. The patient chosen for treatment had not had improvement through a number of conventional therapies and fulfilled the current diagnostic criteria for CRPS-1. ⋯ Although the patient showed an improvement of the cutaneous dystrophic symptoms and diminished pain associated with these lesions, the levels of circulating TNFα increased after the administration of anti-TNFα antibodies. In a patient with CRPS-1 treated with anti-TNFα antibodies, we report increased levels of circulating TNFα and a temporary mitigation of oxidative stress as measured by plasma F2 -isoprostane. This case report provides evidence 2 supporting the indication of monitoring the oxidative stress biomarkers during treatment with anti-TNFα antibodies in CRPS 1.