Background: Repetitive transcranial magnetic stimulation (rTMS) at 5 Hz and 10 Hz is effective in improving pain, sleep quality, and anxiety among patients with postherpetic neuralgia (PHN). But it has not been reported which frequency is more effective and which frequency is safer. Objectives: This study aimed to observe the efficacy and safety of rTMS at different high frequencies (5 Hz, 10 Hz) for PHN. Study Design: The design of the study was a prospective randomized, controlled clinical trial. Setting: The research was conducted within a department of pain management at a university hospital in China. Methods: Sixty patients with PHN who were treated at the Department of Pain Management at Xuanwu Hospital of Capital Medical University were recruited. Using a computer-created number list, the cases were equally divided into 3 groups (n = 20), namely, the sham rTMS group, 5-Hz rTMS group, and 10-Hz rTMS group. The sham rTMS group received sham stimulation, and the other 2 groups received high-frequency (5-Hz and 10-Hz) rTMS, respectively. The primary motor cortex (M1) on the healthy side was stimulated with an intensity of 80% transcranial magnetic stimulation (RMT). For the 5-Hz rTMS group, each stimulation session consisted of a series of 300 one-second pulses with a frequency of 5 Hz and an interval of 2.5 seconds between each train, giving a total of 1500 pulses per session. For the 10-Hz rTMS group, each stimulation session consisted of a series of 300 0.5-second pulses with a frequency of 10 Hz and an interval of 3 seconds between each train, giving a total of 1500 pulses per session; the total time of stimulations was 17.5 minutes. rTMS was performed once daily for 10 days. The 3 groups received conventional medication therapy. Baseline data (gender, age, course of disease, affected side) were recorded in the 3 groups. At different time points (before treatment, T0; during treatment, T1-T10; 1 month after treatment, T11; and 3 months after treatment, T12), the patients were evaluated on the following scales: Visual Analog Scale (VAS), short-form McGill Pain Questionnaire (SF-MPQ), Quality of Life (QOL) scale, sleep quality (SQ) scale, Self-Rating Depression Scale (SDS), Patient Global Impression of Change (PGIC), and incidence of adverse events. Results: Compared with the sham rTMS group, there was a significant reduction in VAS scores in the 5-Hz rTMS group and 10-Hz rTMS group at T2-T12 (P < .05). VAS scores in the 10-Hz rTMS group at T7-T12 were significantly lower compared with the 5-Hz rTMS group (P < .05). The average VAS reduction was significantly different between the 5-Hz and 10-Hz rTMS groups; 28.3% (95% confidence interval [CI],19.48%-49.35%), compared to 39.89% (95% CI, 22.47%- 58.64%), with (F = 5.289, P = .022). The 3 groups did not differ significantly in general SF-MPQ, QOL, SQ, SDS, and PGIC scores. However, the QQL, SQ, and PGIC scores of the 5-Hz rTMS group and the 10-HZ rTMS group at T12 were significantly higher than that of the sham rTMS group. Limitations: The study’s follow-up period was limited to 3 months. Conclusions: rTMS at either frequency, 5 Hz or 10 Hz, relieved PHN and improved the patients’ quality of life. rTMS at 10 Hz was superior to rTMS at 5 Hz in terms of pain relief, quality of life, and improvement in sleep quality, though the latter had higher safety. rTMS at either 5 Hz or 10 Hz can be used as an adjuvant therapy for PHN. Key words: Repetitive transcranial magnetic stimulation, postherpetic neuralgia, pain evaluation
Objective:We have reported the presence of discogenic visceral pain secondary to anterior herniation of the lumbar disc. The aim of this study was to observe the inflammatory response of the sympathetic trunk to an autologous degenerative nucleus pulposus (NP) injection under fluoroscopy. Methods: A total of 72 rats were used. In 24 rats, the autologous NP suspension was injected into the right sympathetic trunk. Next, food intake and body weight of each rat were monitored for 14 days. Fourteen days after the injection, the right lumbar sympathetic trunk was harvested for histological assessment, and protein levels of IL-1 β, IL-6, and TNF-α were quantified via ELISA. Results: In the NP-treated group, endoneural hyperemia and intensive infiltration of inflammatory cells could be identified in sections of the sympathetic trunk by the hematoxylin and eosin (H&E) stain. Meanwhile, elevated concentrations of IL-1 β, IL-6, and TNF-α were determined in the sympathetic trunk of the NP group as compared to that of the naïve and control groups, which indicated the development of an inflammatory response. Furthermore, food intake and body weight of rats in the NP group decreased significantly. Conclusions: The results indicated that an inflammatory response in the sympathetic trunk can be caused by anterior herniation of the lumbar disc, which can generate a sympathetic inflammatory pain response.Citation Tang YZ, Bian JJ, Guo YN, Sun CL, Wei Y, Li XH, Ni JX. Effects of degenerative autologous nucleus pulposus on lumbar sympathetic trunk in rats: sympathetic inflammation.
Objective. This experiment was designed to determine whether erythropoietin-producing human hepatocellular carcinoma (Eph) receptors were involved in the development of visceral pain. Methods. Adult male Sprague-Dawley rats were randomly divided into three groups receiving different treatments (n = 16 per group): intracolonic vehicle (control group), intracolonic 2, 4, 6-trinitrobenzene sulfonic acid (TNBS) (TNBS group), and intracolonic TNBS and intrathecal EphB1 receptor blocking reagent (TNBS + EphB2-Fc group). Visceral hyperalgesia was evaluated with quantification of visceral pain threshold induced by colorectal distention. The spinal expressions of EphB1 and ephrinB2 and levels of their phosphorylated forms (p-EphB1 and p-ephrinB2) were assessed by Western blotting and immunohistochemistry. Results. The TNBS-treated rats developed significant visceral hyperalgesia. The spinal expressions of EphB1, p-EphB1, ephrinB2, and p-ephrinB2 were significantly increased in the TNBS group compared with the control group, but visceral hyperalgesia and elevation of spinal EphB1 and p-EphB1 expressions were evidently alleviated by intrathecal administration of EphB2-Fc in the TNBS + EphB2-Fc group. The number of EphB1- and p-EphB1-immunopositive cells, the average optical (AO) value of EphB1, and its phosphorylated form in the spinal dorsal horn were significantly increased in the TNBS group than in the control group, but they were obviously reduced by intrathecal administration of EphB2-Fc. There were no significant differences in the number of ephrinB2- and p-ephrinB2-immunopositive cells and the AO value of ephrinB2 and its phosphorylated form between the TNBS and TNBS + EphB2-Fc groups. Conclusion. EphB1 receptors in the spinal dorsal horn play a pivotal role in the development of visceral pain and may be considered as a potential target for the treatment of visceral pain.
Objective:We have reported the presence of discogenic visceral pain secondary to anterior herniation of the lumbar disc. The aim of this study was to observe the inflammatory response of the sympathetic trunk to an autologous degenerative nucleus pulposus (NP) injection under fluoroscopy. Methods: A total of 72 rats were used. In 24 rats, the autologous NP suspension was injected into the right sympathetic trunk. Next, food intake and body weight of each rat were monitored for 14 days. Fourteen days after the injection, the right lumbar sympathetic trunk was harvested for histological assessment, and protein levels of IL-1 β, IL-6, and TNF-α were quantified via ELISA. Results: In the NP-treated group, endoneural hyperemia and intensive infiltration of inflammatory cells could be identified in sections of the sympathetic trunk by the hematoxylin and eosin (H&E) stain. Meanwhile, elevated concentrations of IL-1 β, IL-6, and TNF-α were determined in the sympathetic trunk of the NP group as compared to that of the naïve and control groups, which indicated the development of an inflammatory response. Furthermore, food intake and body weight of rats in the NP group decreased significantly. Conclusions:The results indicated that an inflammatory response in the sympathetic trunk can be caused by anterior herniation of the lumbar disc, which can generate a sympathetic inflammatory pain response.Citation Tang YZ, Bian JJ, Guo YN, Sun CL, Wei Y, Li XH, Ni JX. Effects of degenerative autologous nucleus pulposus on lumbar sympathetic trunk in rats: sympathetic inflammation. Transl. Neurosci. Clin. 2017, 3(4): 213-219.
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