The role of blockades in combined chronic pain treatment after hip joint replacement

Chronic pain is a debilitating condition with major socioeconomic impact, whose neurobiological basis is still not clear. An involvement of the neurovascular unit (NVU) has been recently proposed. In particular, the blood-brain barrier (BBB) and blood-spinal cord barrier (BSCB), two NVU key players, may be affected during the development of chronic pain; in particular, transient permeabilization of the barrier is suggested by several inflammatory- and nerve-injury-based pain models, and we argue that the clarification of molecular BBB/BSCB permeabilization events will shed new light in understanding chronic pain mechanisms. Possible biases in experiments supporting this theory and its translational potentials are discussed. Moving beyond an exclusive focus on the role of the endothelium, we propose that our understanding of the mechanisms subserving chronic pain will benefit from the extension of research efforts to the NVU as a whole. In this view, the available evidence on the interaction between analgesic drugs and the NVU is here reviewed. Chronic pain comorbidities, such as neuroinflammatory and neurodegenerative diseases, are also discussed in view of NVU changes, together with innovative pharmacological solutions targeting NVU components in chronic pain treatment.

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Comparing the role of psychological flexibility and traditional pain management coping strategies in chronic pain treatment outcomes

Behaviour Research and Therapy ◽

10.1016/j.brat.2009.09.011 ◽

2010 ◽

Vol 48 (2) ◽

pp. 141-146 ◽

Cited By ~ 68

Author(s):

Kevin E. Vowles ◽

Lance M. McCracken

Keyword(s):

Chronic Pain ◽

Pain Management ◽

Coping Strategies ◽

Treatment Outcomes ◽

Pain Treatment ◽

Psychological Flexibility ◽

Chronic Pain Treatment

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Supraspinal Mechanisms of Spinal Cord Stimulation for Modulation of Pain

Anesthesiology ◽

10.1097/aln.0000000000002353 ◽

2019 ◽

Vol 130 (4) ◽

pp. 651-665 ◽

Cited By ~ 16

Author(s):

Eellan Sivanesan ◽

Dermot P. Maher ◽

Srinivasa N. Raja ◽

Bengt Linderoth ◽

Yun Guan

Keyword(s):

Spinal Cord ◽

Chronic Pain ◽

Spinal Cord Stimulation ◽

Pain Treatment ◽

Neurologic Diseases ◽

Beneficial Effects ◽

Chronic Pain Treatment ◽

Sites Of Action ◽

Pain Inhibition

Abstract The field of spinal cord stimulation is expanding rapidly, with new waveform paradigms asserting supraspinal sites of action. The scope of treatment applications is also broadening from chronic pain to include cerebral ischemia, dystonia, tremor, multiple sclerosis, Parkinson disease, neuropsychiatric disorders, memory, addiction, cognitive function, and other neurologic diseases. The role of neurostimulation as an alternative strategy to opioids for chronic pain treatment is under robust discussion in both scientific and public forums. An understanding of the supraspinal mechanisms underlying the beneficial effects of spinal cord stimulation will aid in the appropriate application and development of optimal stimulation strategies for modulating pain signaling pathways. In this review, the authors focus on clinical and preclinical studies that indicate the role of supraspinal mechanisms in spinal cord stimulation–induced pain inhibition, and explore directions for future investigations.

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The role of ABC transporters of the blood-brain barrier in opioid tolerance development

Postępy Higieny i Medycyny Doświadczalnej ◽

10.5604/01.3001.0010.8805 ◽

2018 ◽

Vol 72 ◽

pp. 58-68

Author(s):

Kamila Środa-Pomianek ◽

Anna Palko-Łabuz ◽

Przemysław Pomianek ◽

Olga Wesołowska

Keyword(s):

Chronic Pain ◽

Substrate Specificity ◽

Blood Brain Barrier ◽

Abc Transporters ◽

Pain Treatment ◽

Brain Barrier ◽

P Glycoprotein ◽

Blood Brain ◽

Chronic Pain Treatment

Opioids constitute an important group of drugs used in chronic pain treatment, e.g. cancer pain. Unfortunately, the development of the organism’s tolerance to the analgesic activity of opioids, the tendency to develop addictions and undesirable side effects are the main causes reducing opioid efficiency in chronic pain treatment. Among many mechanisms connected to emerging of opioid resistance the ATP-binding cassette (ABC) transporters present at the blood-brain barrier may play an important role. These transporter proteins, especially P-glycoprotein (ABCB1, MDR1), affect pharmacokinetics of many drugs and xenobiotics that are their substrates. ABC transporters reduce cellular uptake of drugs and/or increase their export from brain tissue to blood. Substrate specificity of P-glycoprotein is extremely wide and comprises many structurally and functionally unrelated compounds. What is interesting, substrate specificity of P-glycoprotein overlaps to a great extent the specificity of the isoforms of cytochrome P450 involved in drug metabolism. In the present review, the ABC proteins-mediated transport of opioids was discussed as well as the mechanisms of transport regulation. Cellular metabolism of various opioid drugs and the role of ABC transporters in their absorption, distribution and elimination were also described.

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