Sympathetic Blocks Provided Sustained Pain Relief in a Patient with Refractory Painful Diabetic Neuropathy

The sympathetic nervous system has been implicated in pain associated with painful diabetic neuropathy. However, therapeutic intervention targeted at the sympathetic nervous system has not been established. We thus tested the hypothesis that sympathetic nerve blocks significantly reduce pain in a patient with painful diabetic neuropathy who has failed multiple pharmacological treatments. The diagnosis of small fiber sensory neuropathy was based on clinical presentations and confirmed by skin biopsies. A series of 9 lumbar sympathetic blocks over a 26-month period provided sustained pain relief in his legs. Additional thoracic paravertebral blocks further provided control of the pain in the trunk which can occasionally be seen in severe diabetic neuropathy cases, consequent to extensive involvement of the intercostal nerves. These blocks provided sustained and significant pain relief and improvement of quality of life over a period of more than two years. We thus provided the first clinical evidence supporting the notion that sympathetic nervous system plays a critical role in painful diabetic neuropathy and sympathetic blocks can be an effective management modality of painful diabetic neuropathy. We concluded that the sympathetic nervous system is a valuable therapeutic target of pharmacological and interventional modalities of treatments in painful diabetic neuropathy patients.

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CNS origins of the sympathetic nervous system outflow to brown adipose tissue

AJP Regulatory Integrative and Comparative Physiology ◽

10.1152/ajpregu.1999.276.6.r1569 ◽

1999 ◽

Vol 276 (6) ◽

pp. R1569-R1578 ◽

Cited By ~ 70

Author(s):

Maryam Bamshad ◽

C. Kay Song ◽

Timothy J. Bartness

Keyword(s):

Nervous System ◽

Adipose Tissue ◽

Sympathetic Nervous System ◽

Brown Adipose Tissue ◽

Pseudorabies Virus ◽

Critical Role ◽

Hypothalamic Nucleus ◽

Brown Adipose ◽

Sympathetic Nervous ◽

Diet Induced Thermogenesis

Brown adipose tissue (BAT) plays a critical role in cold- and diet-induced thermogenesis. Although BAT is densely innervated by the sympathetic nervous system (SNS), little is known about the central nervous system (CNS) origins of this innervation. The purpose of the present experiment was to determine the neuroanatomic chain of functionally connected neurons from the CNS to BAT. A transneuronal viral tract tracer, Bartha’s K strain of the pseudorabies virus (PRV), was injected into the interscapular BAT of Siberian hamsters. The animals were killed 4 and 6 days postinjection, and the infected neurons were visualized by immunocytochemistry. PRV-infected neurons were found in the spinal cord, brain stem, midbrain, and forebrain. The intensity of labeled neurons in the forebrain varied from heavy infections in the medial preoptic area and paraventricular hypothalamic nucleus to few infections in the ventromedial hypothalamic nucleus, with moderate infections in the suprachiasmatic and lateral hypothalamic nuclei. These results define the SNS outflow from the brain to BAT for the first time in any species.

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Sympathetic Blocks

10.2310/anes.18315 ◽

2021 ◽

Author(s):

Christopher J. Gilligan ◽

Shafik Boyaji

Keyword(s):

Nervous System ◽

Autonomic Nervous System ◽

Sympathetic Nervous System ◽

Stellate Ganglion ◽

Phantom Pain ◽

Celiac Plexus Block ◽

Autonomic Nervous ◽

Sympathetic Nervous ◽

Plexus Block ◽

Sympathetic Blocks

The autonomic nervous system (ANS) is the part of the nervous system that regulates involuntary functions. It is composed of the sympathetic and the parasympathetic nervous systems (SNS and PNS, respectively). The sympathetic nervous system, in addition to its vital role as part of the autonomic nervous system and the emergency response, is thought to be involved in numerous pathologic, painful conditions. These conditions are referred to as Sympathetically Mediated Pain (SMP). SMP is often considered a result of a vicious circle of events, which include changes in peripheral and central somatosensory processes. This assumption is based upon the observations that the pain is spatially correlated with signs of autonomic dysfunction, blocking the efferent sympathetic supply to the affected area would relieve the pain. Sympathetic blocks emerged as a way to help diagnose and treat several painful conditions, including complex regional pain syndrome (CRPS), phantom pain, neuralgias, herpes zoster, and even fibromyalgia. Additionally, sympathetic blockades have been used to improve perfusion, treat angina and malignant arrhythmias, and posttraumatic stress disorder (PTSD) symptoms. This review contains 1 table and 68 references. Key words: Sympathetic nervous system, sympathetically mediated pain, sympathetic blocks, neuropathic pain, chronic pain, stellate ganglion block, celiac plexus block, lumbar sympathetic block, superior hypogastric plexus block

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Bacillus anthracis lethal toxin alters regulation of visceral sympathetic nerve discharge

Journal of Applied Physiology ◽

10.1152/japplphysiol.01105.2011 ◽

2012 ◽

Vol 112 (6) ◽

pp. 1033-1040 ◽

Cited By ~ 6

Author(s):

A. A. Garcia ◽

R. J. Fels ◽

L. J. Mosher ◽

M. J. Kenney

Keyword(s):

Nervous System ◽

Sympathetic Nervous System ◽

Bacillus Anthracis ◽

Sympathetic Nerve ◽

Critical Role ◽

Lethal Factor ◽

Lethal Toxin ◽

Arterial Blood ◽

Sympathetic Nervous ◽

Nerve Discharge

Bacillus anthracis infection is a pathophysiological condition that is complicated by progressive decreases in mean arterial pressure (MAP). Lethal toxin (LeTx) is central to the pathogenesis of B. anthracis infection, and the sympathetic nervous system plays a critical role in physiological regulation of acute stressors. However, the effect of LeTx on sympathetic nerve discharge (SND), a critical link between central sympathetic neural circuits and MAP regulation, remains unknown. We determined visceral (renal, splenic, and adrenal) SND responses to continuous infusion of LeTx [lethal factor (100 μg/kg) + protective antigen (200 μg/kg) infused at 0.5 ml/h for ≤6 h] and vehicle (infused at 0.5 ml/h) in anesthetized, baroreceptor-intact and baroreceptor (sinoaortic)-denervated (SAD) Sprague-Dawley rats. LeTx infusions produced an initial state of cardiovascular and sympathetic nervous system activation in intact and SAD rats. Subsequent to peak LeTx-induced increases in arterial blood pressure, intact rats demonstrated a marked hypotension that was accompanied by significant reductions in SND (renal and splenic) and heart rate (HR) from peak levels. After peak LeTx-induced pressor and sympathoexcitatory responses in SAD rats, MAP, SND (renal, splenic, and adrenal), and HR were progressively and significantly reduced, supporting the hypothesis that LeTx alters the central regulation of sympathetic nerve outflow. These findings demonstrate that the regulation of visceral SND is altered in a complex manner during continuous anthrax LeTx infusions and suggest that sympathetic nervous system dysregulation may contribute to the marked hypotension accompanying B. anthracis infection.

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