BACKGROUND & AIMS: :The feasibility of using a subcutaneously implanted portal system attached to a conventional 16-gauge epidural catheter has been evaluated in 50 patients with sever pain associated with cancer. This technique allowed for the percutaneous epidural administration of morphine at 8-12-hourly intervals for pain control. The mean duration of implantation was 12 weeks and the longest period a portal remained in situ was 36 weeks. Five portals had to be removed for various reasons. The injection system has blocked on eight occasions due to catheter blockage (six times) and portal blockage (two occasions). These patients have continued to obtain excellent analgesia when either catheter or portal were replaced. In a cadaver, 300 injections were simulated using either 22-gauge Huber point needles or disposable needles (25 gauge) and the injectate examined by both light and scanning electron microscopy. Both needle types resulted in particulate contamination which was greater with the recommended Huber point needles.

背景与目标： : 已在50例与癌症相关的严重疼痛患者中评估了使用固定在常规16号硬膜外导管上的皮下植入门静脉系统的可行性。该技术允许以8-12小时的间隔经皮硬膜外施用吗啡以控制疼痛。植入的平均持续时间为12周，而原位保留的最长时间为36周。由于各种原因，必须删除五个门户。由于导管阻塞 (六次) 和门静脉阻塞 (两次)，注射系统有八次阻塞。当更换导管或门静脉时，这些患者继续获得出色的镇痛效果。在尸体中，使用22号Huber点针或一次性针 (25号) 模拟300注射，并通过光学和扫描电子显微镜检查注射物。两种类型的针头都会导致颗粒污染，推荐的Huber点针头会更大。

BACKGROUND & AIMS: :Neuropathic pain is a result of complex interactions between peripheral and central mechanisms with multiple potential therapeutic targets. However, the complexity of these mechanisms and relative youth of translational pain research, which is in its infancy, have prevented translation of successful basic bench research to human therapy. Most of the clinically available neuropathic pain treatments are borrowed from other therapeutic areas, such as antidepressants and antiepileptics, or involve application of older therapy, such as opioids. Exceptions are ziconotide, tapentadol, and the high-concentration capsaicin patch. Similar to all other analgesic agents, these provide only partial pain relief in subsets of patients. The standard of care for patients with chronic neuropathic pain is multimodal and multidisciplinary. For most patients to achieve and maintain satisfactory pain relief a combination of therapeutic agents is necessary, providing the empiric basis for rational polypharmacy, which has become a standard approach as well.

背景与目标： 神经性疼痛是周围和中枢机制与多个潜在治疗靶点之间复杂相互作用的结果。然而，这些机制的复杂性以及尚处于起步阶段的转化疼痛研究的相对年轻，阻碍了成功的基础研究转化为人类治疗。大多数临床上可用的神经性疼痛治疗方法都是从其他治疗领域借来的，例如抗抑郁药和抗癫痫药，或者涉及应用较旧的治疗方法，例如阿片类药物。齐康宁、他喷他多和高浓度辣椒素贴剂是例外。与所有其他镇痛剂相似，这些镇痛剂仅可部分缓解患者的疼痛。慢性神经性疼痛患者的护理标准是多模式和多学科。为了使大多数患者达到并保持令人满意的疼痛缓解，必须结合治疗剂，为合理的多药治疗提供经验基础，这也已成为一种标准方法。

BACKGROUND & AIMS: OBJECTIVE:Anticipated pain with intrauterine device (IUD) insertion may be a barrier to widespread use. Our objective was to evaluate the efficacy of intracervical 2% lidocaine gel for pain relief with IUD insertion. STUDY DESIGN:We performed a double-blind, randomized controlled trial of women undergoing IUD insertion. Participants were randomly assigned to 2% lidocaine or placebo gel. Study gel (3 mL) was placed 3 minutes prior to IUD insertion. Pain scores were measured at various time points using a 10-point visual analog scale. RESULTS:Of the 200 participants randomized, 199 completed the study. Pain scores among lidocaine and placebo arms were similar at tenaculum placement (lidocaine and placebo: median, 4; range, 0-10; P = .15) and with insertion (lidocaine: median, 5; range, 1-10; placebo: median, 6; range, 0-10; P = .16). These results did not differ by parity. CONCLUSION:Topical or intracervical 2% lidocaine gel prior to IUD insertion does not decrease pain scores.

背景与目标：

BACKGROUND & AIMS: BACKGROUND:Many brain areas participate to supraspinal control of nociception. In these regions, few studies have investigated the role of glial cells in supraspinal plasticity and the effect of 7-day intrathecal nerve growth factor-like (BB14®, Blueprint Biotech, Milano, Italy) treatment. METHODS:In male Sprague-Dawley rats, we evaluated by immunohistochemistry the morphological and molecular rearrangement of neuroglial network occurring in several supraspinal brain regions involved in pain processing following spared nerve injury (SNI) of the sciatic nerve. In particular, the medial prefrontal cortex, the amygdala (Amy), the nucleus accumbens (Acb), the thalamus and the periaqueductal gray were analysed. RESULTS:Despite the modifications occurring in the dorsal horn of spinal cord following SNI, no significant changes in the Iba1 and glial fibrillary acidic protein (GFAP) expression were detected in all the analysed supraspinal regions, except for the Amy, showing a remarkable GFAP increase. Interestingly, neuropathic rats also displayed a significant increase of glial transporters (GTs) in all the supraspinal regions. Finally, the analysis of vesicular glutamate transporter 1 (vGLUT1) and vesicular gamma-aminobutyric acid (GABA) transporter (vGAT) expression revealed a significant enhancement of glutamatergic/GABAergic ratio in all selected brain regions of SNI animals, except for Acb. Both glial activation in the Amy and alteration of GTs and vGLUT/vGAT levels observed in neuropathic animals were largely reversed by BB14® treatment. CONCLUSIONS:All together, these data strengthen the role of supraspinal neuroglial network plasticity in the establishment of neuropathic pain syndrome. The hallmark is represented by the divergence between glial reaction confined to Amy and the widespread changes in the GT distribution and glutamate/GABA ratio detected in the other supraspinal region.

背景与目标：

BACKGROUND & AIMS: OBJECTIVE:Although there is evidence for a beneficial effect of increased quadriceps strength on knee symptoms, the effect on knee structure is unclear. We undertook this study to examine the relationship between change in vastus medialis cross-sectional area (CSA) and knee pain, tibial cartilage volume, and risk of knee replacement in subjects with symptomatic knee osteoarthritis (OA). METHODS:One hundred seventeen subjects with symptomatic knee OA underwent magnetic resonance imaging of the knee at baseline and at 2 and 4.5 years. Vastus medialis CSA was measured at baseline and at 2 years. Tibial cartilage volume was measured at baseline and at 2 and 4.5 years. Knee pain was assessed by the Western Ontario and McMaster Universities Osteoarthritis Index at baseline and at 2 years. The frequency of knee joint replacement over 4 years was determined. Regression coefficients (B) and odds ratios were determined along with 95% confidence intervals (95% CIs). RESULTS:After adjusting for confounders, baseline vastus medialis CSA was inversely associated with current knee pain (r = -0.16, P = 0.04) and with medial tibial cartilage volume loss from baseline to 2 years (B coefficient -10.9 [95% CI -19.5, -2.3]), but not with baseline tibial cartilage volume. In addition, an increase in vastus medialis CSA from baseline to 2 years was associated with reduced knee pain over the same time period (r = 0.24, P = 0.007), reduced medial tibial cartilage loss from 2 to 4.5 years (B coefficient -16.8 [95% CI -28.9, -4.6]), and reduced risk of knee replacement over 4 years (odds ratio 0.61 [95% CI 0.40, 0.94]). CONCLUSION:In a population of patients with symptomatic knee OA, increased vastus medialis size was associated with reduced knee pain and beneficial structural changes at the knee, suggesting that management of knee pain and optimizing vastus medialis size are important in reducing OA progression and subsequent knee replacement.

背景与目标：

BACKGROUND & AIMS: :Previous surveys showed a poor quality of the web sites providing health information about low back pain. However, the rapid and continuous evolution of the Internet content may question the current validity of those investigations. The present study is aimed to quantitatively assess the quality of the Internet information about low back pain retrieved with the most commonly employed search engines. An Internet search with the keywords "low back pain" has been performed with Google, Yahoo!® and Bing™ in the English language. The top 30 hits obtained with each search engine were evaluated by five independent raters and averaged following criteria derived from previous works. All search results were categorized as declaring compliant to a quality standard for health information (e.g. HONCode) or not and based on the web site type (Institutional, Free informative, Commercial, News, Social Network, Unknown). The quality of the hits retrieved by the three search engines was extremely similar. The web sites had a clear purpose, were easy to navigate, and mostly lacked in validity and quality of the provided links. The conformity to a quality standard was correlated with a marked greater quality of the web sites in all respects. Institutional web sites had the best validity and ease of use. Free informative web sites had good quality but a markedly lower validity compared to Institutional websites. Commercial web sites provided more biased information. News web sites were well designed and easy to use, but lacked in validity. The average quality of the hits retrieved by the most commonly employed search engines could be defined as satisfactory and favorably comparable with previous investigations. Awareness of the user about checking the quality of the information remains of concern.

背景与目标： : 以前的调查显示，提供腰痛健康信息的网站质量很差。然而，互联网内容的快速和持续发展可能会质疑这些调查的当前有效性。本研究旨在定量评估使用最常用的搜索引擎检索到的有关下背痛的互联网信息的质量。Google，Yahoo!进行了带有关键字 “腰痛” 的互联网搜索。®和必应™用英语。每个搜索引擎获得的前30名点击率由五个独立的评分者进行评估，并按照先前作品得出的标准进行平均。所有搜索结果都被分类为声明是否符合健康信息的质量标准 (例如HONCode)，并且基于网站类型 (机构，免费信息，商业，新闻，社交网络，未知)。这三个搜索引擎检索到的点击质量极其相似。这些网站有明确的目的，易于浏览，并且大多缺乏所提供链接的有效性和质量。对质量标准的符合性与网站在各个方面的明显更高的质量相关。机构网站具有最佳的有效性和易用性。与机构网站相比，免费的信息网站质量良好，但有效性明显较低。商业网站提供了更多有偏见的信息。新闻网站设计精良，易于使用，但缺乏有效性。最常用的搜索引擎检索到的点击的平均质量可以定义为令人满意的，并且可以与以前的调查进行比较。用户对检查信息质量的意识仍然值得关注。

BACKGROUND & AIMS: :To evaluate the effectiveness of intravenous clodronate in ameliorating refractory bone pain in patients with metastatic bone disease, 60 patients with established osseous metastases and persistent bone pain were randomized to receive either clodronate (600 mg or 1500 mg in 500 mL of normal saline) or 500 mL of saline as placebo. After 2 weeks, the patients were crossed over to receive the alternate treatment. After another 2 weeks, each patient and investigator made a blinded choice. Daily visual analogue scales (VAS) and analgesic diaries were recorded throughout the study period. Forty-six patients were evaluable (77%). A treatment x period interaction was identified in the VAS and daily morphine equivalent dose (DMED) scores. First period analysis of the VAS scores for general pain, pain at rest, and pain upon movement demonstrated an average reduction of 13, 14, and 24 mm, respectively, from baseline, but were not significantly different from changes following placebo. The average change in DMED was -6.4 (SE = 2.9) following clodronate and was +24.6 (SE = 14.9) following placebo (p = 0.03). In the blinded choice of which agent resulted in improvement in pain, 26 (57%) patients chose clodronate, 12 (26%) chose placebo, and eight (17%) had no preference (p = 0.0021). For the investigators who also made a blinded selection, clodronate was chosen in 30 (65%) patients, placebo in ten (22%) patients, and no difference was apparent in six (13%) (p < 0.0001). Intravenous clodronate appeared to have analgesic effect in patients with refractory bone pain due to metastatic bone disease. The optimal dose and duration of effect require further evaluation, particularly in patients with stable disease and persistent bone pain.

背景与目标： : 为了评估静脉注射氯膦酸盐缓解转移性骨病患者难治性骨痛的有效性，将60例已确定骨转移和持续性骨痛的患者随机分为氯膦酸盐 (600 mg或1500 mg，500 mL生理盐水) 或500 mL生理盐水作为安慰剂。2周后，患者交叉接受替代治疗。再过2周后，每位患者和研究者都做出了盲法选择。在整个研究期间记录每日视觉模拟量表 (VAS) 和镇痛日记。46例患者可评估 (77%)。在VAS和每日吗啡等效剂量 (DMED) 评分中确定了治疗x期相互作用。一般疼痛，静息疼痛和运动时疼痛的VAS评分的第一阶段分析显示，与基线相比分别平均降低了13、14和24毫米，但与安慰剂后的变化没有显着差异。氯膦酸盐后DMED的平均变化为-6.4 (SE = 2.9)，安慰剂后为 + 24.6 (SE = 14.9) (p = 0.03)。在盲目选择哪种药物导致疼痛改善的过程中，26 (57%) 名患者选择氯膦酸盐，12 (26%) 选择安慰剂，8 (17%) 没有偏好 (p = 0.0021)。对于也进行盲法选择的研究者，在30 (65%) 例患者中选择氯膦酸盐，在10 (22%) 例患者中选择安慰剂，在6 (13%) 例患者中没有明显差异 (p <0.0001)。静脉注射氯膦酸盐似乎对转移性骨病引起的难治性骨痛患者具有镇痛作用。最佳剂量和效果持续时间需要进一步评估，尤其是在疾病稳定和持续性骨痛的患者中。

BACKGROUND & AIMS: :Opioid rotation is increasingly becoming an option to improve pain management especially in long-term treatment. Because of insufficient analgesia and intolerable side effects, a total of 42 patients (23 male, 19 female; mean age 64.1 years) suffering from severe musculoskeletal (64%), cancer (21%) or neuropathic (19%) pain were converted from high-dose morphine (120 to >240 mg/day) to transdermal buprenorphine. The dose of buprenorphine necessary for conversion (at least 52.5 microg/h) was titrated individually by the treating physician. No conversion recommendations were given and the treating physician used his or her own judgment for dose adjustment. Pain relief, overall satisfaction and quality of sleep (very good, good, satisfactory, poor, or very poor), and the incidence and severity of adverse drug reactions over a period of at least 10 weeks and up to 1 year was assessed. Following rotation, patients experiencing good/very good pain relief increased from 5% to 76% (P < 0.001). Only 5% reported insufficient relief. Relief was achieved with buprenorphine alone in 77.4%, while 17% needed an additional opioid for breakthrough pain. Sleep quality (good/very good) increased from 14% to 74% (P < 0.005). Adverse effects were reported in 11.9%, mostly because of local irritation, did not result in termination of therapy. Neither tolerance nor refractory effect following rotation from morphine to buprenorphine was noted. Conversion tables with a fixed conversion ratio are of limited value in patients treated with high-dose morphine.

背景与目标： : 阿片类药物旋转正日益成为改善疼痛管理的一种选择，尤其是在长期治疗中。由于镇痛不足和无法忍受的副作用，共有42例患者 (男性23例，女性19例; 平均年龄64.1岁) 患有严重的肌肉骨骼 (64% 例)，癌症 (21%) 或神经性 (19%) 疼痛从大剂量吗啡 (120至> 240 mg/天) 转化为透皮丁丙诺啡。转化所需的丁丙诺啡剂量 (至少52.5微克/小时) 由治疗医师单独滴定。没有给出转换建议，治疗医生使用他或她自己的判断进行剂量调整。评估了疼痛缓解，总体满意度和睡眠质量 (非常好，良好，满意，差或非常差)，以及至少10周和长达1年的药物不良反应的发生率和严重程度。旋转后，疼痛缓解良好/非常好的患者从5% 增加到76% (P <0.001)。只有5% 报告救济不足。77.4% 年仅使用丁丙诺啡可缓解，而17% 需要额外的阿片类药物来缓解突破性疼痛。睡眠质量 (良好/非常好) 从14% 增加到74% (P <0.005)。11.9% 年报告了不良反应，主要是由于局部刺激，并未导致治疗终止。从吗啡旋转为丁丙诺啡后，没有发现耐受性或难治性。在接受大剂量吗啡治疗的患者中，具有固定转换率的转换表的价值有限。

BACKGROUND & AIMS: :The complex problem of combined neck and shoulder pain was investigated in 26 operations in 13 patients who had a shoulder procedure (subacromial decompressions or rotator cuff repairs) and an anterior cervical spine fusion. This select group of complex patients illustrates the diagnostic studies required to determine whether the pain comes primarily from the cervical spine, shoulder, or both. Good pain relief was accomplished after 24 of the 26 surgical procedures (average follow-up, 4.3 years). In the 13 patients, eight presented with nearly equal neck and shoulder pain as the chief complaint, whereas in the remaining five patients, the initial complaint was predominantly neck pain with only minor shoulder involvement. The shoulder pain became more significant after the anterior cervical fusion in these five patients. This study emphasizes the need for a careful evaluation of patients with combined neck-shoulder pain syndrome in a systematic approach allowing appropriate treatment.

背景与目标： : 在13例接受肩部手术 (肩峰下减压或肩袖修复) 和颈椎前路融合术的患者中，对26例颈肩疼痛的复杂问题进行了研究。这一组复杂的患者说明了诊断研究，以确定疼痛是否主要来自颈椎，肩膀或两者。在26次外科手术中的24次 (平均随访4.3年) 后，疼痛缓解良好。在13例患者中，有8例的颈部和肩部疼痛几乎是主要主诉，而在其余5例患者中，最初的主诉主要是颈部疼痛，仅轻微的肩部受累。在这五名患者中，颈椎前路融合后，肩部疼痛变得更加明显。这项研究强调需要以系统的方法对合并颈肩疼痛综合征的患者进行仔细评估，以进行适当的治疗。

BACKGROUND & AIMS: BACKGROUND:Shoulder tip and abdominal pain following laparoscopic procedures are well recognized causes of postoperative morbidity. In this double-blind randomized clinical trial attempts were made to reduce postoperative pain in patients undergoing laparoscopic surgery by implementing a simple intraoperative technique. METHODS:Patients undergoing elective laparoscopic cholecystectomy or laparoscopic transabdominal preperitoneal inguinal hernia repair were randomized to receive either the current standard treatment (control group) or an intervention to remove residual carbon dioxide. In the intervention group, the pneumoperitoneum was removed at the end of the operation by placing the patient in the Trendelenburg position and utilizing a pulmonary recruitment manoeuvre consisting of two manual inflations to a maximum pressure of 60 cmH2 O. In the control group, residual pneumoperitoneum was evacuated at the end of the procedure by passive decompression via the open operative ports. RESULTS:Seventy-six randomly assigned patients, 37 in the intervention group and 39 in the control group, were recruited. Overall postoperative pain scores were significantly lower in the intervention group (P = 0·001). Median (interquartile range) pain scores were significantly lower in the intervention group compared with the control group at both 12 h (3·5 versus 5; P < 0·010) and 24 h (3 versus 4·5; P < 0·010). CONCLUSION:Active evacuation of residual pneumoperitoneum following laparoscopic procedures, by means of two pulmonary recruitment manoeuvres in the Trendelenburg position, reduces postoperative pain significantly. This simple and safe technique can be implemented routinely after abdominal laparoscopy. REGISTRATION NUMBER:NCT01720433 (http://www.clinical trials.gov).

背景与目标：

BACKGROUND & AIMS: BACKGROUND:Modic changes (MC) are associated with low back pain (LBP). In this study, we compared changes in size and type of MC, after a single intravenous infusion of 5 mg zoledronic acid (ZA) or placebo, among chronic LBP patients with MC on magnetic resonance imaging (MRI), and evaluated whether the MRI changes correlate with symptoms. METHODS:All patients (N = 19 in ZA, 20 in placebo) had MRI at baseline (0.23-1.5 T) and at one year (1.5-3 T). We evaluated the level, type and volume of all the MC. The MC were classified into M1 (M1 (100%)), predominating M1 (M1/2 (65:35%)) or predominating M2 (M1/2 (35:65%)), and M2 (M2 (100%)). The first two were considered M1-dominant, and the latter two M2-dominant. Volumes of M1 and M2 were calculated separately for the primary MC, which was assumed to cause the symptoms, and the other MC. We analysed the one-year treatment differences in M1 and M2 volumes using analysis of covariance with adjustments for age, sex, body mass index, and smoking. The correlations between the MRI changes and the changes in LBP symptoms were analysed using Pearson correlations. RESULTS:In the ZA group, 84.2% of patients had M1-dominant primary MC at baseline, compared to 50% in the placebo group (p = 0.041). The primary MC in the ZA group converted more likely to M2-dominant (42.1% ZA, 15% placebo; p = 0.0119). The other MC (15 ZA, 8 placebo) were on average 42% smaller and remained largely M2-dominant. The M1 volume of the primary MC decreased in the ZA group, but increased in the placebo group (-0.83 cm3 vs 0.91 cm3; p = 0.21). The adjusted treatment difference for M1 volume was -1.9 cm3 (95% CI -5.0 to 1.2; p = 0.22) and for M2 volume 0.23 cm3 (p = 0.86). In the MC that remained M1-dominant, volume change correlated positively with increased symptoms in the placebo group, whereas the correlations were negative and weak in the ZA group. CONCLUSIONS:Zoledronic acid tended to speed up the conversion of M1-dominant into M2-dominant MC and decrease the volume of M1-dominant MC, although statistical significance was not demonstrated. TRIAL REGISTRATION:The registration number in ClinicalTrials.gov is NCT01330238 and the date of registration February 11, 2011.

背景与目标：

BACKGROUND & AIMS: BACKGROUND:In the past, the efficacy of local infiltration of liposomal bupivacaine for total hip arthroplasty (THA) patients was in debate. Therefore, this meta-analysis was conducted to determine whether local infiltration of liposomal bupivacaine provides better pain relief after THA. METHODS:We searched Web of Science, PubMed, Embase, and the Cochrane Library databases to the April 2017. Any studies comparing liposomal bupivacaine and traditional bupivacaine were included in our meta-analysis. The outcomes included visual analog scale (VAS) at 24, 48, and 72 hours, total morphine consumption at 24 hours, and the length of hospital stay. We assessed the pooled data using a random-effect model. RESULTS:Six studies were finally included in this meta-analysis. Our pooled data analysis demonstrated that liposomal bupivacaine was more effective than the traditional bupivacaine in terms of VAS at 24 hours (P  =  .018) and the length of hospital stay (P  =  .000). There was no significant difference in terms of the VAS at 48 and 72 hours and total morphine consumption at 24 hours (P >.05). CONCLUSION:Compared with the traditional bupivacaine, liposomal bupivacaine shows better pain control at 24 hours and reduces the length of hospital stay after THA. Its economic costs must be assessed in multimodal center randomized controlled trials when being recommended as a long-acting alternative analgesic agent for a THA patient.

背景与目标：

BACKGROUND & AIMS: :Application of functional imaging techniques to animal models is vital to understand pain mechanisms, but is often confounded by the need to limit movement artefacts with anaesthesia, and a focus on evoked responses rather than clinically relevant spontaneous pain and related hyperalgesia. The aim of the present study was to investigate the potential of manganese-enhanced magnetic resonance imaging (MEMRI) to measure neural responses during on-going pain that underpins hyperalgesia in pre-clinical models of nociception. As a proof of concept that MEMRI is sensitive to the neural activity of spontaneous, intermittent behaviour, we studied a separate positive control group undergoing a voluntary running wheel experiment. In the pain models, pain behaviour (weight bearing asymmetry and hindpaw withdrawal thresholds (PWTs)) was measured at baseline and following either intra-articular injection of nerve growth factor (NGF, 10µg/50µl; acute pain model, n=4 rats per group), or the chondrocyte toxin monosodium iodoacetate (MIA, 1mg/50µl; chronic model, n=8 rats per group), or control injection. Separate groups of rats underwent a voluntary wheel running protocol (n=8 rats per group). Rats were administered with paramagnetic ion Mn2+ as soluble MnCl2 over seven days (subcutaneous osmotic pump) to allow cumulative activity-dependent neural accumulation in the models of pain, or over a period of running. T1-weighted MR imaging at 7T was performed under isoflurane anaesthesia using a receive-only rat head coil in combination with a 72mm volume coil for excitation. The pain models resulted in weight bearing asymmetry (NGF: 20.0 ± 5.2%, MIA: 15 ± 3%), and a reduction in PWT in the MIA model (8.3 ± 1.5g) on the final day of assessment before undergoing MR imaging. Voxel-wise and region-based analysis of MEMRI data did not identify group differences in T1 signal. However, MnCl2 accumulation in the VTA, right Ce amygdala, and left cingulate was negatively correlated with pain responses (greater differences in weight bearing), similarly MnCl2 accumulation was reduced in the VTA in line with hyperalgesia (lower PWTs), which suggests reduced regional activation as a result of the intensity and duration of pain experienced during the 7 days of MnCl2 exposure. Motor cortex T1-weighted signal increase was associated with the distance ran in the wheel running study, while no between group difference was seen. Our data suggest that on-going pain related signal changes identified using MEMRI offers a new window to study the neural underpinnings of spontaneous pain in rats.

背景与目标： : 将功能成像技术应用于动物模型对于了解疼痛机制至关重要，但通常由于需要限制麻醉的运动伪影，并且关注诱发反应而不是临床相关的自发性疼痛和相关的痛觉过敏而感到困惑。本研究的目的是研究锰增强磁共振成像 (MEMRI) 在持续疼痛期间测量神经反应的潜力，这种疼痛是伤害感受的临床前模型中痛觉过敏的基础。为了证明MEMRI对自发的间歇性行为的神经活动敏感，我们研究了一个单独的阳性对照组，并进行了自愿的跑步轮实验。在疼痛模型中，在基线和关节内注射神经生长因子 (NGF，10 µ g/50 µ l; 急性疼痛模型，每组n = 4只大鼠) 后测量疼痛行为 (负重不对称和后爪戒断阈值 (PWTs))，或软骨细胞毒素碘乙酸单钠 (MIA，1mg/50 µ l; 慢性模型，每组n = 8只大鼠) 或对照注射。不同组的大鼠接受了自愿轮跑方案 (每组n = 8只大鼠)。在7天内 (皮下渗透泵) 给大鼠以顺磁性离子Mn2作为可溶性MnCl2，以允许在疼痛模型中或在一段时间内累积活动依赖性神经积累。在异氟醚麻醉下，使用仅接收的大鼠头线圈和72毫米体积线圈进行激发，在7t下进行T1-weighted MR成像。疼痛模型导致负重不对称 (NGF: 20.0 ± 5.2%，MIA: 15 ± 3%)，并且在进行MR成像之前的评估的最后一天，MIA模型中的PWT降低 (8.3 ± 1.5g)。对MEMRI数据进行的体素分析和基于区域的分析未识别T1信号的组差异。然而，VTA，右Ce杏仁核和左扣带回中的MnCl2积累与疼痛反应呈负相关 (负重差异更大)，类似地，VTA中的MnCl2积累与痛觉过敏 (较低的PWTs) 相一致，这表明由于MnCl2暴露7天期间经历的疼痛强度和持续时间导致区域激活减少。在车轮运行研究中，运动皮层T1-weighted信号的增加与行驶距离有关，而组之间没有差异。我们的数据表明，使用MEMRI识别出的与疼痛相关的持续信号变化为研究大鼠自发性疼痛的神经基础提供了新的窗口。

BACKGROUND & AIMS: BACKGROUND AND OBJECTIVES:Damage to peripheral nerves provokes chronic neuropathic pain that lasts beyond the duration of the nerve injury. The presence of pain signs have been reported in areas other than those attributed to the injured nerve, i.e., in contralateral regions. We evaluated the presence, magnitude, and chronology of mechanical and cold allodynia in the contralateral paw of rats undergoing unilateral ligation of the L5 and L6 spinal nerves. METHODS:Twenty-three male Sprague-Dawley rats underwent spinal nerve ligation of the left L5 and L6 spinal nerves (SNL group) and 7 rats received a sham surgery without nerve ligation (sham group). Signs of mechanical allodynia as assessed with von Frey filaments, and cold allodynia as assessed with the acetone drop test, were studied before surgery and throughout 21 postoperative days. Responses of ipsilateral and contralateral paws of the SNL group were compared between themselves and with those in the sham group. RESULTS:Rats in the SNL group developed mechanical and cold allodynia responses in the ipsilateral paw, and also in the contralateral paw. Allodynia in the contralateral paw appeared later, becoming statistically significant on day 10 after surgery for mechanical allodynia and on day 21 for cold allodynia as compared with the sham group. Contralateral pain was of a lower intensity than on the ipsilateral side. CONCLUSIONS:After L5 and L6 spinal nerve ligation, rats developed mechanical and cold allodynia in the contralateral paw, suggesting extraterritorial development of neuropathic signs. This finding has implications for future study design and therapeutic approaches.

背景与目标：

BACKGROUND & AIMS: :Laparoscopy is frequently associated with postoperative shoulder pain that may last several days. We have assessed the analgesic effect of intraperitoneal local anaesthetics during day-case diagnostic laparoscopy. 80 young women were randomly assigned to one of four groups of 20 patients each: group 1, no peritoneal administration; group 2, 80 ml saline injected under direct vision in the right subdiaphragmatic area at the start of the procedure; group 3, 80 ml 0.5% lignocaine with adrenaline (320,000 dilution); group 4, 0.125% bupivacaine with adrenaline (800,000 dilution). Scapular pain was assessed with a visual analogue pain scale, and information about nausea, vomiting, abdominal pain, and analgesic requirements during the first 48 h was sought. Both local anaesthetics were more effective in reducing postoperative shoulder pain than either control or saline. Analgesic requirements were greater in the non-treatment groups than in the local anaesthetic groups. Intraperitoneal local anaesthetic administration during laparoscopy is both a non-invasive and an efficient method of reducing the intensity of scapular pain.

背景与目标： : 腹腔镜检查通常与可能持续数天的术后肩部疼痛有关。我们在日间诊断性腹腔镜检查中评估了腹膜内局部麻醉剂的镇痛作用。80名年轻女性被随机分配到四组中的一组，每组20名患者: 第1组，不腹膜给药; 第2组，在手术开始时在右侧膈下区域直视下注射80毫升生理盐水; 第3组，用肾上腺素 (320,000稀释) 80毫升0.5% 利多卡因; 第4组，0.125% 布比卡因与肾上腺素 (800,000稀释)。用视觉模拟疼痛量表评估肩cap骨疼痛，并寻求有关头48小时内恶心，呕吐，腹痛和镇痛需求的信息。与对照组或生理盐水相比，两种局部麻醉剂在减轻术后肩部疼痛方面都更有效。非治疗组的镇痛需求高于局部麻醉组。腹腔镜检查过程中腹膜内局部麻醉给药既是一种非侵入性的，也是减轻肩胛骨疼痛强度的有效方法。