Articles: peripheral-nerve-injuries.
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Reg Anesth Pain Med · Feb 2025
Role of spinal Barrier-to-Autointegration Factor (BAF) in the epigenetic silencing of the mu-opioid receptor gene in neuropathic pain.
Neuropathic pain presents a significant clinical challenge, with spinal cord epigenetic mechanisms playing a critical role in its development. This study investigated the impact of nerve injury on the Barrier-to-Autointegration Factor (BAF) in the rat spinal dorsal horn. ⋯ These findings suggest that spinal pNR2B receptors may activate BAF, which interacts with LEMD2 to enhance EZH2-mediated H3K27me3 at the mu-opioid receptor promoter after nerve injury. Targeting this pathway may offer novel strategies to inhibit neuropathic pain.
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Reg Anesth Pain Med · Feb 2025
ReviewPostamputation pain: a multidisciplinary review of epidemiology, mechanisms, prevention, and treatment.
Despite humanity's long experience with amputations, postamputation pain remains a highly prevalent, incompletely understood, and clinically challenging condition. There are two main types of postamputation pain: residual limb pain (including but not limited to the "stump") and phantom limb pain. ⋯ Central, peripheral, and spinal mechanisms may all contribute to the protean manifestations of persistent postamputation pain; an improved understanding of these mechanisms will be essential to identify the most promising interventions for the prevention and treatment of postamputation pain. Although there are currently no standardized prevention or treatment recommendations for any type of postamputation pain, an evidence-based, multimodal strategy including pharmacological agents, nonsurgical procedures, surgery, complementary and integrative techniques, and assistive technologies may prevent the development of chronic postamputation pain after amputation and/or optimize treatment outcomes.
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Reg Anesth Pain Med · Jan 2025
Real time continuous monitoring of injection pressure at the needle tip is better than ultrasound in early detecting intraneural injection.
During peripheral nerve blocks, inadvertent intraneural injection is not infrequent. Recently, with sonographic nerve swelling, it has been shown that intraneural injection can be detected as early as 0.4 mL. A new method based on injection pressure monitoring at the needle tip, the real pressure in the tissues, is compared with sonographic performance in early detection of intraneural injection. ⋯ Pressure monitoring at the needle tip consistently showed a pressure rise from the onset of injection and proved to be a more sensitive and earlier indicator of intraneural injection than sonographic nerve swelling.