Articles: chronic.
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Migraine is a complex neurovascular disorder that is one of the leading causes of disability and a reduced quality of life. Even with such a high societal impact, our understanding of the cellular and molecular mechanisms that contribute to migraine headaches is limited. To address this complex disorder, several groups have performed genome-wide association studies to elucidate migraine susceptibility genes, with many identifying transient receptor potential melastatin 8 (TRPM8), a cold-sensitive cation channel expressed in peripheral afferents innervating the trigeminovascular system, and the principal mediator of cold and cold pain associated with injury and disease. ⋯ Our results show that both evoked and spontaneous pain behaviors are dependent on both TRPM8 channels and neurons, as well as required in both acute and chronic migraine models. Moreover, inhibition of TRPM8 channels prevented acute but not established chronic migraine-like pain. These results are consistent with its association with migraine in genetic analyses and establish that TRPM8 channels are a component of the underlying mechanisms of migraine.
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Chronic noncancer pain in children and adolescents can be impairing and results in substantial health care costs. Intensive interdisciplinary pain treatment (IIPT), an inpatient or day hospital treatment delivered by a team of 3 or more health professionals, may be an effective intervention for these children and adolescents. Based on previous reviews and meta-analyses, we updated findings regarding the description of available treatments and estimated the effectiveness of IIPT, overcoming methodological shortcomings of previous work by requesting and analyzing individual participant data. ⋯ Regarding treatment effectiveness, IIPT may result in large improvements in the mean pain intensity ( g = -1.28), disability ( g = -1.91), and number of missed school days at the 12-month follow-up ( g = -0.99), as well as moderate improvements in anxiety ( g = -0.77) and depression ( g = -0.76). The certainty of the evidence, however, was graded from very low to low. We recommend that future researchers use more scientific rigor to increase the certainty of the evidence for IIPT and standardize treatment outcomes for children and adolescents with chronic pain.
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Randomized Controlled Trial
Safety and efficacy of continuous subcutaneous foslevodopa-foscarbidopa in patients with advanced Parkinson's disease: a randomised, double-blind, active-controlled, phase 3 trial.
Levodopa is the most effective symptomatic therapy for Parkinson's disease, but patients with advanced Parkinson's disease develop motor fluctuations with chronic oral levodopa therapy. Foslevodopa-foscarbidopa is a soluble formulation of levodopa and carbidopa prodrugs that is delivered as a 24-h/day continuous subcutaneous infusion, and we aimed to assess the safety and efficacy of this formulation in patients with advanced Parkinson's disease. ⋯ AbbVie.
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Semin Respir Crit Care Med · Dec 2022
ReviewChronic Thromboembolic Pulmonary Disease and Chronic Thromboembolic Pulmonary Hypertension.
Chronic thromboembolic pulmonary hypertension (CTEPH) and chronic thromboembolic pulmonary disease (CTEPD) are two terms characterizing symptomatic patients with chronic thromboembolic occlusions of pulmonary arteries with or without pulmonary hypertension at rest. Their diagnosis follows evolving schemas that integrate technological advances of pivotal imaging modalities among which computed tomography angiography plays a major role. ⋯ The requirements for imaging at the time of therapeutic decisions are also described in the light of recent updates in the literature from multidisciplinary groups of experts. Because an early diagnosis of CTEPH remains a challenge for the medical community, several practical issues are included in this article with the objective of improving the knowledge and collaboration between radiologists and clinicians in service to the patient.