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The Journal of Pain Nov 2019Exercise is considered an important component of effective chronic pain management and it is well-established that long-term exercise training provides pain relief. In... (Review)
Review
Exercise is considered an important component of effective chronic pain management and it is well-established that long-term exercise training provides pain relief. In healthy, pain-free populations, a single bout of aerobic or resistance exercise typically leads to exercise-induced hypoalgesia (EIH), a generalized reduction in pain and pain sensitivity that occurs during exercise and for some time afterward. In contrast, EIH is more variable in chronic pain populations and is more frequently impaired; with pain and pain sensitivity decreasing, remaining unchanged or, in some cases, even increasing in response to exercise. Pain exacerbation with exercise may be a major barrier to adherence, precipitating a cycle of physical inactivity that can lead to long-term worsening of both pain and disability. To optimize the therapeutic benefits of exercise, it is important to understand how EIH works, why it may be impaired in some people with chronic pain, and how this should be addressed in clinical practice. In this article, we provide an overview of EIH across different chronic pain conditions. We discuss possible biological mechanisms of EIH and the potential influence of sex and psychosocial factors, both in pain-free adults and, where possible, in individuals with chronic pain. The clinical implications of impaired EIH are discussed and recommendations are made for future research, including further exploration of individual differences in EIH, the relationship between exercise dose and EIH, the efficacy of combined treatments and the use of alternative measures to quantify EIH. PERSPECTIVE: This article provides a contemporary review of the acute effects of exercise on pain and pain sensitivity, including in people with chronic pain conditions. Existing findings are critically reviewed, clinical implications are discussed, and recommendations are offered for future research.
Topics: Chronic Pain; Exercise; Humans; Hyperalgesia; Hypesthesia; Pain Perception; Pain Threshold
PubMed: 30904519
DOI: 10.1016/j.jpain.2019.03.005 -
Cancer Oct 2022To explore the impact of acupuncture with other complementary and integrative medicine (CIM) modalities on chemotherapy-induced peripheral neuropathy (CIPN) and quality... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
To explore the impact of acupuncture with other complementary and integrative medicine (CIM) modalities on chemotherapy-induced peripheral neuropathy (CIPN) and quality of life (QoL) in oncology patients.
METHODS
In this prospective, pragmatic, and patient-preference study, patients with CIPN were treated with acupuncture and CIM therapies (intervention group) or standard care alone (controls) for 6 weeks. Patients in the intervention arm were randomized to twice-weekly acupuncture-only (group A) or acupuncture with additional manual-movement or mind-body CIM therapies (group B). Severity of CIPN was assessed at baseline and at 6 weeks using the Functional Assessment of Cancer Therapy-Taxane (FACT-Tax) tool. Other QoL-related outcomes were assessed with the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC); and the Measure Yourself Concerns and Well-being questionnaire. Von Frey measurements examined perception thresholds.
RESULTS
Of 168 participants, 136 underwent the study intervention (group A, 69; group B, 67), with 32 controls. Baseline-to-6-week assessment scores improved significantly in the intervention arm (vs controls) on FACT-Tax (p = .038) and emotional well-being (p = .04) scores; FACT-TAX scores for hand numbness/tingling (p = .007) and discomfort (p < .0001); and EORTC physical functioning (p = .045). Intervention groups A and B showed improved FACT-Tax physical well-being (p < .001), FACT-TAX total score (p < .001), FACT-TAX feet discomfort (p = .003), and EORTC pain (p = .017) scores.
CONCLUSIONS
Acupuncture, with or without CIM modalities, can relieve CIPN-related symptoms during oncology treatment. This is most pronounced for hand numbness, tingling, pain, discomfort, and for physical functioning.
Topics: Acupuncture Therapy; Antineoplastic Agents; Humans; Hypesthesia; Neoplasms; Pain; Peripheral Nervous System Diseases; Prospective Studies; Quality of Life; Taxoids
PubMed: 35960141
DOI: 10.1002/cncr.34422 -
Ophthalmologica. Journal International... 2014Neurotrophic keratitis (NK) is a rare degenerative corneal disease that occurs as a result of partial or total impairment of trigeminal innervations, leading to a... (Review)
Review
Neurotrophic keratitis (NK) is a rare degenerative corneal disease that occurs as a result of partial or total impairment of trigeminal innervations, leading to a reduction (hypoesthesia) in or loss (anaesthesia) of corneal sensitivity. The impairment of sensory innervation causes a reduction in the lacrimation reflex and the vitality, metabolism and mitosis of epithelial cells, with subsequent deficiency in epithelial repair, stromal and intracellular oedema, loss of microvilli, and abnormal development of the basal lamina. Several recent studies have proposed different therapies based on different aetiopathogenetic theories. The aim of the therapy is to treat aetiopathogenesis and, at the same time, promote corneal healing. In this paper, we report the aetiology, diagnosis, management, and medical and surgical treatment of NK, also indicating future treatments based on the most recent studies.
Topics: Anesthesia; Animals; Cornea; Humans; Hypesthesia; Keratitis; Trigeminal Nerve Diseases
PubMed: 24107451
DOI: 10.1159/000354380 -
Tidsskrift For Den Norske Laegeforening... Feb 2022Numb chin syndrome describes sensory neuropathy characterised by numbness in the distribution of the terminal branch of the mandibular division of the trigeminal nerve....
BACKGROUND
Numb chin syndrome describes sensory neuropathy characterised by numbness in the distribution of the terminal branch of the mandibular division of the trigeminal nerve. This symptom may be overlooked by patients and clinicians due to its mild nature; however, it could represent a serious underlying pathology such as inflammatory conditions or malignancy.
CASE PRESENTATION
A man in his seventies presented with isolated numbness on the right side of the chin, and no other neurological or constitutional symptoms. Radiology showed a lytic mass in the right side of the mandible protruding through the mental foramen. A multidisciplinary approach revealed the cause of the patient's numb chin syndrome.
INTERPRETATION
This case report illustrates clinical considerations in a patient with numb chin syndrome.
Topics: Chin; Humans; Hypesthesia; Male; Neoplasms
PubMed: 35170922
DOI: 10.4045/tidsskr.21.0160 -
Archivio Italiano Di Urologia,... Jun 2022Cycling is a popular means of transport and recreational activity; bicycles are also a source of genitourinary injuries and there is the idea that cycling may have a...
INTRODUCTION
Cycling is a popular means of transport and recreational activity; bicycles are also a source of genitourinary injuries and there is the idea that cycling may have a significant impact on sexual function. The objective of this study was to evaluate the effect of amateur cycling on erectile function.
METHODS
We used a questionnaire comparing amateur cyclists (n = 199) and footballers (n = 43), regarding sexual related comorbidities and hours of practice per week. The cyclists were also characterized in terms of road vs cross-country, breaks during cycling, saddle, and shorts. To evaluate erectile function, the International Index of Erectile Function questionnaire was applied.
RESULTS
there was no difference in International Index of Erectile Function total score between groups. Age and presence of erectile dysfunction associated comorbidity were negative factors in the International Index of Erectile Function score in cyclists but not in the footballers.
CONCLUSIONS
Cycling is usually associated with perineal numbness, but that numbness did not lead to lower International Index of Erectile Function scores. In conclusion amateur cycling has no effect on EF.
Topics: Bicycling; Erectile Dysfunction; Humans; Hypesthesia; Male; Perineum; Surveys and Questionnaires
PubMed: 35775353
DOI: 10.4081/aiua.2022.2.232 -
Medicine Jul 2022Capillary hemangioma in the spinal cord is an exceedingly rare entity that is liable to be misdiagnosed. To summarize the clinical presentation, radiological...
RATIONALE
Capillary hemangioma in the spinal cord is an exceedingly rare entity that is liable to be misdiagnosed. To summarize the clinical presentation, radiological characteristics, and pathological features of capillary hemangioma in the spinal cord and to share our experience for the diagnosis and treatment of intradural extramedullary capillary hemangioma.
PATIENT CONCERNS
Three patients underwent surgical treatment at our hospital between January 2020 and August 2020. All patients were male[median age at presentation: 57 years (range: 56-60)]. Two patients were experiencing pain and numbness in the lower back, and 1 patient was experiencing numbness and weakness in the left lower limb. The duration of symptoms ranged from 1 to 5 months.
DIAGNOSIS
All patients were diagnosed with spinal cord capillary hemangioma after treatment. All lesions were in an intradural extramedullary location and involved spinal cord components. Two patients had lesions in thoracic segments (T8, Th9-10), and 1 patient had a lesion in lumbar segment (L1).
INTERVENTIONS
All patients underwent microscopic laminectomy and complete resection of the extramedullary and intramedullary components of the spinal cord capillary hemangiomas.
OUTCOMES
Postoperatively, all patients experienced transient numbness and pain in the lower limbs, which gradually decreased over time. None of the patients experienced bleeding, severe numbness or pain, or recurrence of symptoms at 3-month follow-up.
CONCLUSION
Intradural extramedullary capillary hemangioma has unique morphological characteristics. Gross-total resection of the extramedullary and intramedullary components of spinal cord capillary hemangioma is recommended for patients with symptoms of spinal cord compression. Careful preoperative imaging and intraoperative decision-making may help avoid residual lesions or reoperation.
Topics: Female; Hemangioma, Capillary; Humans; Hypesthesia; Laminectomy; Magnetic Resonance Imaging; Male; Pain; Spinal Cord Neoplasms
PubMed: 35905223
DOI: 10.1097/MD.0000000000029862 -
Journal of Hospital Medicine Apr 2020
Topics: Abdominal Pain; Adult; Female; Humans; Hypesthesia; Immunologic Factors; Methylprednisolone; Multiple Sclerosis; Natalizumab; Neuroprotective Agents
PubMed: 32118562
DOI: 10.12788/jhm.3358 -
Frontiers in Immunology 2023Recent studies have reported that similar to other IgG4 autoimmune diseases, such as muscle-specific kinase antibody-associated myasthenia gravis, most...
BACKGROUND
Recent studies have reported that similar to other IgG4 autoimmune diseases, such as muscle-specific kinase antibody-associated myasthenia gravis, most anti-neurofascin-155 (anti-NF155) nodopathies respond well to rituximab treatment, regardless of the dosage. However, there are still a few patients for which rituximab is ineffective for unknown reasons. Currently, there are no studies on the mechanism of ineffective treatment with rituximab.
METHODS
A 33-year-old Chinese man presenting with numbness, tremor, and muscle weakness for 4 years was recruited for this study. Anti-NF155 antibodies were identified by cell-based assay and confirmed by immunofluorescence assay on teased fibers. The anti-NF155 immunoglobulin (IgG) subclasses were also detected by immunofluorescence assay. Anti-rituximab antibodies (ARAs) were quantitatively analyzed using enzyme-linked immunosorbent assay (ELISA), and peripheral B cell counts were determined by flow cytometry.
RESULTS
The patient exhibited anti-NF155 IgG4-antibody positivity. After the first round of rituximab infusion, the patient showed stratified outcomes with improvements in numbness, muscle weakness and ambulation. However, after three rounds of rituximab infusion, the patient's symptoms deteriorated, and the numbness, tremor and muscle weakness returned. No obvious improvement was found after plasma exchange and another round of rituximab treatment. 14 days after the last treatment with rituximab, ARAs were detected. And the titers gradually decreased on day 28 and 60 but remained higher than normal. Peripheral CD19 B cell counts were less than 1% within the 2-month period following the final rituximab administration.
CONCLUSIONS
In this study, ARAs presented in a patient with anti-NF155 nodopathy undergoing rituximab treatment and showed an unfavorable impact on rituximab efficacy. This is the first case to report the occurrence of ARAs in patients with anti-NF155 antibodies. We suggest that ARAs should be tested early during the initial intervention, especially in patients who respond poorly to rituximab treatment. In addition, we believe it is necessary to investigate the association between ARAs and B cell counts, their effect on clinical efficacy, and their potential adverse reactions in a larger cohort of patients with anti-NF155 nodopathy.
Topics: Male; Humans; Adult; Rituximab; Tremor; Hypesthesia; Polyradiculoneuropathy, Chronic Inflammatory Demyelinating; Autoantibodies; Cell Adhesion Molecules; Immunoglobulin G; Muscle Weakness
PubMed: 37056784
DOI: 10.3389/fimmu.2023.1121705 -
Annals of Clinical and Translational... Jun 2023Nodal/paranodal autoantibodies identified a group of peripheral neuropathies independent from chronic inflammatory demyelinating polyneuropathy (CIDP). However,...
OBJECTIVE
Nodal/paranodal autoantibodies identified a group of peripheral neuropathies independent from chronic inflammatory demyelinating polyneuropathy (CIDP). However, nodopathy with antibody against neurofascin 186 (NF186) was rarely reported. We presented a cohort of patients with anti-NF186 antibody and described the clinical profile of them.
METHODS
In this retrospective study, 195 patients diagnosed with CIDP and immune mediated idiopathic neuropathies were enrolled. Cell-based assay was used to screen anti-NF186 and anti-NF155 antibodies in serum samples. Teased-fiber immunofluorescence were used as a confirmatory assay. Clinical data of seropositive patients were collected and analyzed.
RESULTS
Among the patients with anti-NF186 antibody, seven patients (58.3%) presented acute or subacute disorder onset. Four patients (33.3%) were found to have asymmetric weakness or numbness. Distal weakness and/or numbness was the core feature. Sensory ataxia, tremor and central nervous system demyelination were rarely observed. Nerve conduction studies revealed predominant demyelinating with/without axonal loss. Brachial plexus MRI was normal in the majority of patients (6/7, 85.7%). Five patients (5/9, 55.6%) showed response to intravenous immunoglobulin. Eight patients (8/10, 80.0%) improved after corticosteroids. All patients (3/3,100%) responded to rituximab.
INTERPRETATION
In the study, we depicted the clinical profile of nodopathy with anti-NF186 antibody. The diversity of clinical features, electrophysiology results and pathological findings was specific in nodopathy with anti-NF186 antibody. Screening of autoantibody against NF186 in acute-onset neuropathy is recommended.
Topics: Humans; Polyradiculoneuropathy, Chronic Inflammatory Demyelinating; Retrospective Studies; Hypesthesia; Cell Adhesion Molecules; Nerve Growth Factors; Autoantibodies
PubMed: 37060203
DOI: 10.1002/acn3.51775 -
Brain and Behavior Apr 2022To review the clinical symptoms, auxiliary examination findings, and outcomes of patients with nitrous oxide (N O) abuse, and analyze the factors that affect outcomes.
PURPOSE
To review the clinical symptoms, auxiliary examination findings, and outcomes of patients with nitrous oxide (N O) abuse, and analyze the factors that affect outcomes.
METHODS
Patients with N O abuse treated in the Department of Neurology between January 2018 and December 2020 were included. The clinical data of these patients were collected, and follow-up was conducted to determine the outcomes.
RESULTS
The average age of the 110 patients with N O abuse was 21.4 ± 4.2 years (range: 14-33 years). Clinical presentation primarily included neurological symptoms, such as limb numbness and/or weakness (97%), psychiatric symptoms, changes in appetite, and skin hyperpigmentation. Laboratory test results were characterized by vitamin B deficiency (60%, 34 out of 57 cases) and high homocysteine level (69%, 31 out of 45 cases). Electromyography indicated mixed axonal and demyelination injury (92%, 80 out of 87 cases). Motor and sensory nerves were simultaneously involved, and injury primarily involved the lower limbs. One hundred and seven (97%) patients were clinically diagnosed with peripheral neuropathy, of whom 26 (24%) exhibited spinal abnormalities on magnetic resonance imaging, supporting a diagnosis of subacute combined degeneration. Treatment included N O withdrawal and vitamin B supplementation. Reexamination of six patients indicated that treatment was effective. Follow-up was completed for 51 patients. Thirty-four patients (67%) recovered completely, 17 patients (33%) had residual limb numbness, and only one patient experienced relapse. Sex was an independent prognostic factor; the outcomes of female patients were better than that of male patients.
CONCLUSION
The recreational use of N O has largely expanded among youth in recent decades, which has become a growing public health concern in China. It highlights the importance of the recognition of various clinical symptoms, particularly limb numbness and/or weakness related to the cases of N O abuse. The therapeutic administration of vitamin B supplementation and N O withdrawal can make the overall prognosis good, especially for female patients.
Topics: Adolescent; Adult; Female; Humans; Hypesthesia; Male; Nitrous Oxide; Prognosis; Vitamin B 12; Vitamin B 12 Deficiency; Vitamins; Young Adult
PubMed: 35307992
DOI: 10.1002/brb3.2533