Symposia Report Immunoglobulin G for the Treatment of Chronic Pain:Report of an Expert Workshop

背景:慢性疼痛的治疗效果仍不理想.尽管现在治疗慢性疼痛的药物种类较多,但许多患者对疗效仍不满意或诉药物的副作用太大.越来越多的证据表明,免疫系统参与了伤害性和神经病理性慢性疼痛的病理过程.设计:在英国利物浦的专题会议上,专家们出示了免疫系统参与慢性疼痛的证据.近来的研究表明,静脉(IVIg)或皮下(SCIg)注射免疫调节药物——多价免疫球蛋白(IgG)可缓解外周神经病理性疼痛和其他疼痛性疾病.专题会议讨论了IVIg和SCIg治疗的适应证、效价比及其副作用.结果:IgG可缓解某些伤害性和神经病理性慢性疼痛,如糖尿病、干燥综合征、纤维肌痛症、复杂性区域疼痛综合征、小儿麻痹后遗症和继发于病理性自身抗体的疼痛.结论:IgG对某些慢性疼痛具有一定的治疗前景.IgG是一种相对安全的治疗方法,副作用少而轻,但价格较贵.今后有必要对IgG治疗顽固性疼痛进行随机对照研究和预测性临床试验.

Of the three cardinal manifestations of chronic pancreatitispain, diabetes mellitus and steatorrhea, it is pain that brings the patient to the physician and is the most difficult to manage. The intractabale pain that is quite debilitating disrupts lifestyle and leads to functional incapacity, drug and alcohol dependency, and a drug-seeking behavior that occasionally might push the desperate patient to suicidal tendency. Painless CP is an exception that has been observed in nearly 5% to 10% of patients with all forms of chronic pancreatitis. Lack of pain is also a feature of the late onset idiopathic CP.

人工髋膝置换术后慢性疼痛原因分析

人工髋、膝关节置换( TKA，THA )是治疗晚期髋、膝关节病变的有效方法，临床10年随访的结果显示，其有效率达92%～98%[1]。然而，疼痛，既是髋、膝关节置换手术的主要适应证，也是人工髋、膝关节置换术的常见并发症。疼痛也是骨关节科的一个普遍的、容易被忽视的问题[2]。人工关节置换术后出现经久不愈的疼痛，预示手术可能失败。人工髋、膝关节置换术后发生慢性持续疼痛的原因虽各有不同，但在大方向分类上，髋膝关节置换术后慢性疼痛有许多一致性，同时在一些具体原因上也有一定相关性，故将两者合并回顾。

人工髋膝置换术后慢性疼痛原因分析

人工髋、膝关节置换( TKA，THA )是治疗晚期髋、膝关节病变的有效方法，临床10年随访的结果显示，其有效率达92%～98%[1]。然而，疼痛，既是髋、膝关节置换手术的主要适应证，也是人工髋、膝关节置换术的常见并发症。疼痛也是骨关节科的一个普遍的、容易被忽视的问题[2]。人工关节置换术后出现经久不愈的疼痛，预示手术可能失败。人工髋、膝关节置换术后发生慢性持续疼痛的原因虽各有不同，但在大方向分类上，髋膝关节置换术后慢性疼痛有许多一致性，同时在一些具体原因上也有一定相关性，故将两者合并回顾。

炎症细胞因子在骨性关节炎疼痛中的作用机制

骨性关节炎 ( osteoarthritis，OA ) 是一种常见的退行性关节病，涉及到整个滑膜关节，包括软骨、滑膜和软骨下骨。OA主要的临床表现是关节的疼痛，这不仅会导致功能受限和生活质量的降低，而且是老年人行动不利的主要原因[1]。有报道，60岁以上的人群中，50%在X线片上有骨性关节炎表现，80%有骨性关节炎症状，并且是致残的主要原因之一[2]。尽管目前对于OA疼痛的确切机制尚不明确，但普遍认为其与膝关节局部炎症相关，炎症细胞因子通过直接或间接的途径诱导痛觉过敏是OA疼痛的原因之一。

The neuropeptides, substance P and calcitonin gene-related peptide, have been shown to be involved in pain transmission and repair of sciatic nerve injury. A model of sciatic nerve defect was prepared by dissecting the sciatic nerve at the middle, left femur in female Sprague Dawley rats. The two ends of the nerve were encased in a silica gel tube. L5 dorsal root ganglia were harvested 7, 14 and 28 days post sciatic nerve injury for immunohistochemical staining. Results showed that substance P and cal-citonin gene-related peptide expression increased significantly in dorsal root ganglion of rats with sci-atic nerve injury. This increase peaked at 7 days, declined at 14 days, and reduced to normal levels by 28 days post injury. The findings indicate that the neuropeptides, substance P and calcitonin gene-related peptide, mainly increased in the early stages after sciatic nerve injury.

Transient receptor potential channel A1 is one of the important transducers of noxious stimuli in the primary afferents, which may contribute to generation of neurogenic inflammation and hyperalgesia. The present study was designed to investigate if activation of transient receptor potential channel A1 may induce calcitonin gene-related peptide release from the primary afferent neurons. We found that application of al yl isothiocyanate, a transient receptor potential channel A1 activator, caused calcitonin gene-related peptide release from the cultured rat dorsal root ganglion neurons. Knock-down of transient receptor potential channel A1 with an antisense oligodeoxynucleotide prevented calcitonin gene-related peptide release by al yl isothiocyanate application in cultured dorsal root ganglion neurons. Thus, we concluded that transient receptor potential channel A1 activation caused calcitonin gene-related peptide release in sensory neurons.

疼痛学科的定位和发展方向

It is clarified which position is propitious to its development by way of the analysis of the development and status quo of algesiology.To consider algesiology as a multidisciplinary specialty at present can be helpful in mobilizing the enthusiasm of part time doctors.The direction of algesiology will be set in independent subject,medical research integration,and remedial popularization.

末期癌症患儿疼痛管理

Data is clear that many children with cancer at the end of life suffer substantially. Treatment was viewed as successful in only 27% of the patients. Pain in children who are dying of cancer can be complex and challenging to manage. Children and parenta are equal partners with members of the health care team in managing the patient's pain. Prevention and alleviation of pain is a primary goal of care in the child dying of cancer. Children dying of cancer may require aggressive dosing of analgesics. Medications that do not have a dose maximum should be escalated, sometimes rapidly, to achieve adequate pain control or to maintain pain control when tolerance has occurred. The nurse' s role in caring for children who are in pain at the end-of-life includes assessment, identifying expected outcomes, and planning, performing, and evaluating interventions.

博宁联合化疗治疗恶性肿瘤骨转称疼痛

Objective To investigate the effect of Boning on pain due to bone metastases from malignant tumors. Method From December,1998 to December,2000,86 patients with pathologically proved bone metastases from malignant tumors were randomly divided into two groups, study group(combined chemotherapy with boning),control group(simple chemotherapy).Boning (60 mg) dissolved in saline solution(500 ml) were given IV for consecutive 3 days. Then 60 mg Boning was given every half month .Patients in control group accepted simple chemotherapy. Results Efficacy in study group was 88.37％ which was significantly superior to that in control group (66.47％ ).Boning could repair injured bone. Adverse reaction associated with Boning was weak. Boning quickly relieved symptoms for a long time. Conclusion Effect of large dose Boning for relieving pain due to bone metastases from malignant tumors is satisfying. At the same time, Boning play important role in repair of destructed bone.

三王止痛膏治疗癌性疼痛60例疗效观察

Objective To observe the therapeutic effect of Sanwang pain alleviating plaster on cancerous pain.Method The study was a randomized,single blinded trial.The patients were randomly divided into 2 groups,study group and control group.Control group received toad plaster.Pain level,functions time and duration of sanwang pain alleviating plaster,quality of life,peripheral blood picture,liver and kidney function,EEG,local stimulation and allergy of skin were evaluated before and after treatment.Result For the study group,total effective rate,duration,KS improvement rate were significantly raised as compared with control group.Total effective rate was different between two groups(P< 0.05) .Conclusion Sanwang pain alleviating plaster can effectively control cancerous pain and improve quality of life.

Objective: To observe the effect of acupoint massage in relieving pain after ureteroscopic holmium laser lithotripsy.
Methods: Ninety-two patients undergone ureteroscopic holmium laser lithotripsy were enrolled and randomized into a treatment group and a control group, 46 in each group. Patients in the control group were given regular nursing care, while patients in the treatment group were intervened by acupoint massage in addition to the regular nursing care. The pain was evaluated by visual analogue scale (VAS) at 6 h, 12 h, and 24 h after operation, and compared between the two groups.
Results:There was no significant difference in comparing the VAS score at 6 h after operation between the two groups (P>0.05). The VAS scores in the treatment group at 12 h and 24 h after operation were significantly lower than those in the control group (both P<0.05). Fewer patients in the treatment group used analgesics compared with those in the control group.
Conclusion: Acupoint massage can effectively relieve the pain after ureteroscopic holmium laser lithotripsy, reduce the use of analgesics, and promote the recovery.

Intradermal administration of formalin to the cheek induces itch as well as pain behaviors in rats

Objective· Formalin is a classic and most widely used algogenic substance,but its itchy effect is not clear.The present study aims to explore the hypothesis that formalin may induce itch as well as pain.Methods· Flinching,as well as licking and forelimb wiping of the site of injection were counted as pain responses,whereas biting and hind paw scratching of the cheek were counted as itchy responses.To discriminate formalin-induced sensations in rats,the irritant (saline as control) was injected,and then pain and itchy responses were recorded.Results · Intraplantar injection of formalin elicited biphasic behavior responses characterized as flinching,as well as biting or licking of the hind paw without significant gender differences.Following intradermal administration of formalin to the cheek,rats exhibited episodic forelimb wiping of the cheek,representative of pain.No gender difference was noticed for this type of behavior.In addition,episodes of hind paw scratches of the cheek,representative of pruritoceptive responses,also occurred.Interestingly,hind paw scratches appeared to be more pronounced in male than in female rats.Conclusion · Intradermal administration of formalin elicits pruritoceptive as well as nociceptive responses in rats.

Objective:The aim of this study was to evaluate the analgesic ef ect of high intensity focused ultrasound (HIFU) in patients with advanced pancreatic cancer. Methods:A total of 106 patients with advanced pancreatic cancer accompanied by abdominal pain were treated by HIFU. Pain intensities and quantities of morphine consumption before and after treatment were observed and compared. Results:The average pain intensities before treatment, and at d3, d7 after treatment were 5.80 ± 2.14, 2.73 ± 2.68, 2.45 ± 2.43 respectively (P<0.01). Fifty-nine cases (55.7%) got to extremely ef ective, and 29 cases (27.4%) ef ective. Total ef icient rate was 83.0%. The average quantities of morphine consumption before and after treatment in the patients with grade III pain were 114.9 ± 132.5 mg, 16.8 ± 39.7 mg each person everyday respectively (P<0.01). Conclusion:HIFU can relieve pain suf ered by patients with pancreatic cancer ef ectively. It is a new adjuvant treatment for pancreatic cancer pain.