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Regenerative Medicine in Pain Management
Published in Sahar Swidan, Matthew Bennett, Advanced Therapeutics in Pain Medicine, 2020
Sharon McQuillan, Rafael Gonzalez
Matrix metalloproteinases (MMPs) are enzymes that are capable of degrading extracellular matrix proteins and can process a number of bioactive molecules. MMPs play a major role in neuroinflammation and pain through the division and suppression of extracellular matrix proteins, cytokines, and chemokines.34 Nerve injury-induced changes in the dorsal root ganglion are responsible for neuropathic pain.35 MMP-9, produced by injured dorsal root ganglions, provokes spinal microglia activation and neuropathic pain development due to MMP-9 pathophysiology, including IL-1 beta cleavage and microglia p38 activation in early-phase neuropathic pain. MMP-2 activation leads to late-phase neuropathic pain via IL-1 beta cleavage and astrocyte ERK activation.35 Tissue inhibitor of metalloproteinases (TIMP) suppress neuropathic pain. TIMP-1 diminishes early-phase neuropathic pain, while TIMP-2 diminishes late-phase neuropathic pain.35
Peripheral Mechanisms of Pain
Published in Peter Kam, Ian Power, Michael J. Cousins, Philip J. Siddal, Principles of Physiology for the Anaesthetist, 2020
Peter Kam, Ian Power, Michael J. Cousins, Philip J. Siddal
The dorsal root ganglion is situated in the lateral foramen between neighbouring vertebral bodies and is in close relationship to the sympathetic chain. It contains the cell bodies for all primary afferents including the nociceptors.
Neurological issues
Published in Andrea Utley, Motor Control, Learning and Development, 2018
The main function of the spinal cord is to act as an interface between the brain and the PNS. The spinal cord comprises both gray and white matter. The gray matter of the spinal cord consists mostly of cell bodies and dendrites. The surrounding white matter is made up of nerve fibers which are bundled together to form tracts that carry information up and down the spinal cord. Thirty-one pairs of spinal nerves, part of the PNS, emerge from the spinal cord. Each nerve has a dorsal root, which carries afferent sensory information to the brain, and a ventral root, which carries efferent or motor information from the brain. The ventral root mostly comprises the axons of alpha motor neurons, whose cell bodies are located in the anterior part of the spinal cord. The dorsal root comprises both the axons of the sensory neurons and their cell bodies, which are clustered together to form the dorsal root ganglion. In addition to carrying electrical impulses to and from the brain, the spinal cord is also involved in reflexes that do not immediately involve the brain; these are often referred to as ‘non-conscious’ spinal reflexes (Latash, 1998).
Long-term follow-up results of surgically treated patients with foraminal and far lateral disc herniations
Published in British Journal of Neurosurgery, 2023
Huseyin Dogu, Nuriye Guzin Ozdemir, Hakan Yilmaz, Ibrahim Burak Atci
Far lateral disc herniations compose 7–12% of all disc herniations. Foraminal, intraforaminal, far lateral or extreme lateral disc herniations are included in the far lateral disc herniation group.1 However, far lateral disc herniation is a term generally used for lumbar disc herniations that compress the exiting nerve root at the same level, lateral to the neural foramen or further.2 The exiting dorsal root ganglion at the same level is affected.3 The diagnosis may be overlooked if one does not investigate the patient’s findings meticulously. Surgical technique requires using a relatively unusual route compared to classic approach for mediolateral discs, however the outcome is highly satisfactory. Series reporting long-term follow-up for foraminal and far lateral discs are few, and also there are not large series to observe the recurrences and outcome.4
Neuropsychiatric manifestations in primary Sjogren syndrome
Published in Expert Review of Clinical Immunology, 2022
Simone Appenzeller, Samuel de Oliveira Andrade, Mariana Freschi Bombini, Samara Rosa Sepresse, Fabiano Reis, Marcondes C. França
The use of immunomodulatory agents is often needed to treat subjects with pSS-related sensory neuronopathy [34]. The goal is to prevent long-term disability. The most prescribed agents are corticosteroids (intravenous pulses) and intravenous immunoglobulins (IVIg), often in combination. In our own experience, steroids are more effective than IVG in the long term. From a pathophysiological perspective, this is consistent because dorsal root ganglia damage in pSS-related sensory neuronopathy is cell-mediated rather then antibody-mediated. Intravenous cyclophosphamide is another option for refractory cases and may be used in combination with steroids. Oral immunosuppressant drugs – such as azathioprine, methotrexate, or mycophenolate – are often used as steroid-sparing agents after remission is achieved. One critical issue about pSS-related sensory neuronopathy treatment is timing. Since this is a cell body disease (which does not regenerate), late intervention can result in poor clinical results. Based on longitudinal nerve conduction data, some authors have estimated the optimal treatment window here to be as short as 8 months from onset [92].
Device profile of the Proclaim XR neurostimulation system for the treatment of chronic pain: an overview of its safety and efficacy
Published in Expert Review of Medical Devices, 2020
Jonathan M. Hagedorn, Alyson M. Engle, Priyanka Ghosh, Timothy R. Deer
Overall, the future is bright for spinal cord and dorsal root ganglion stimulation. Over the next 5 years, devices can be expected to become smaller and more powerful with a premium placed on the patient experience. Non-rechargeable devices with improved energy delivery methods and waveforms can be expected to provide superior outcomes. Devices with the capability to provide multiple waveforms will potentially allow patients to experience decreased loss of efficacy, a potential occurrence with SCS. Magnetic resonance image labeling will continue to improve and, in doing so, will allow the implanted patient to attain the imaging necessary for the best clinical outcomes in all disease states. Tracking of outcomes will become more streamlined with easier and more efficient methods for patient reporting. Communication barriers between the patient and physician will dissolve through the creation of improved industry-provided patient reporting programs. In sum, these changes can be expected to improve neuromodulation outcomes and provide a better overall patient experience.