Assessment and classification of chronic pruritis and its relation to systemic diseases

Although pruritis might not be a serious condition with significant healthcare impacts, it is usually associated with an unpleasant sensation that leads to scratching the skin. It has been demonstrated that the severity of the condition is significantly variable and ranges between disabling and mild conditions. Chronic pruritis has been defined as the presence of daily itching for >6 months. In the present literature review, we have discussed the different approaches that have been previously indicated to assess and evaluate chronic pruritis, and the classification of the condition its relation to the different systemic diseases. The classification of chronic pruritis can be done using a clinical or an etiological diagnosis. The clinical diagnosis is usually based a primary skin condition, while the etiological diagnosis is based on the presence of different diseases that may be systematic, neurological, or psychiatric disorders. Accordingly, conducting a thorough examination is essential to establish a proper diagnosis before adequately managing the affected patients. Furthermore, the treatment of the underlying etiology should also be adequately considered for adequate management and enhanced prognosis.

Evaluation of the effects of cotton roll-biting on debonding pain: a split-mouth study

Introduction: Debonding pain is an unpleasant sensation that is frequently encountered during debonding procedure. Aim of the study: To investigate the effectiveness of cotton roll-biting on pain caused by the debonding procedure. Materials and methods: 102 patients (61 females, 41 males) who were at the debonding stage in orthodontic treatment were included in the research. The study was planned using a split-mouth design: one side of the jaw was the study, and the other side was the control. The anxiety level of participants was measured before debonding. On the study side, debonding was performed while patients were biting a cotton roll. On the control side, debonding was implemented as a routine debonding procedure. Study and control sides were assigned differently in each successive patient. The debonding pain of each tooth was recorded using the Visual Analog Scale prepared separately for each tooth. Shapiro–Wilk and Mann–Whitney U tests were used for statistical analysis. For both gender groups, patients were sequenced according to the average amount of pain per tooth. Subsequently, statistical analysis was repeated by using 50% of patients suffering more pain. Results: In the lower second premolar tooth, a statistically significant difference was detected. Pain scores were statistically higher in the study side for this tooth. No statistically significant differences were found for all other teeth. Conclusions: Cotton roll-biting has no alleviating effect on debonding pain. When debonding is performed gently using a squeezing action without applying torsional forces, additional pain relief methods are not required.

Cellular, circuit and transcriptional framework for modulation of itch in the central amygdala

Itch is an unpleasant sensation that elicits robust scratching and aversive experience. However, the identity of the cells and neural circuits that organize this information remains elusive. Here we show the necessity and sufficiency of chloroquine-activated neurons in the central amygdala (CeA) for both itch sensation and associated aversion. Further, we show that chloroquine-activated CeA neurons play important roles in itch-related comorbidities, including anxiety-like behaviors, but not in some aversive and appetitive behaviors previously ascribed to CeA neurons. RNA-sequencing of chloroquine-activated CeA neurons identified several differentially expressed genes as well as potential key signaling pathways in regulating pruritis. Finally, viral tracing experiments demonstrate that these neurons send projections to the ventral periaqueductal gray that are critical in modulation of itch. These findings reveal a cellular and circuit signature of CeA neurons orchestrating behavioral and affective responses to pruritus in mice.

BAHIPARIMARJANA CHIKITSA OF SHOOLA

To Study the Bahiparimarjana Chikitsa of Shoola from Bhruhatrayi and Laghutrayi. Pain is defined as an Unpleas- ant feeling that is conveyed to Brain by Sensory Neurons. It is an Unpleasant Sensation localised to a part of Body. It is often described in terms of Penetrating or Tissue Destructive Process of Bodily or Emotional Reaction. Pain is main reason for visiting Doctor in 50%of cases. It is a major Symptom in many Medical Conditions and can interfere with Persons quality of Life and General Functioning. Acute Pain is usually managed with Medications such as Analgesic and Anesthetics. Caffeine, Ibuprofen, Ketamine, Opioids are some Pain killers used to treat Pain. In Modern Medicine there are few external treatments to reduce Pain like Spray, Ointment and Gels. But on contrary Ayurveda has many Bahiparimarjana Chikitsa (External Treatments) to reduce Shoola (Pain) like Ahangya (Anointing), Snehana (Oil Massage), Swedan (Sudation), etc. These External Treatments work at Site of Shoola gets absorbed at Skin by Bhrajaka Pitta and medicine reaches to each Tissue of the Body and reduces Shoola. The Popular Verse “Vatat Dhrute Nasit Ruja” means Without Vata Dosha there Cannot be Pain indicates involvement of Vata Dosha in every Pain. The Best Medicine of Vata Dosha is Sneha (Oil/Ghee/ Muscle Fat / Bone Marrow). Vata Dosha and Taila (Oil) both have Opposite Qualities. According to “Samanya Vishesha Siddhant” VataDosha- has Laghu (Light), Ruksha (Rough), Sukshma (Minute), Shita (Cold), Chala (Movable) Guna (Qualities) whereas Sneha (Taila) is Guru (Heavy), Snigdha (Unctuous), Ushna (Warm) Guna. The Sneha reduces Vata Dosha and thereby helps in reducing Shoola. This Paper will emphasize on Types of Bahiparimarjana Chikitsa of Shoola, Number of Bahiparimarjana Chikitsa mentioned for particular type of Shoola and Mode of Action of Bahiparimar- jana Chikitsa. Keywords: Shoola, Bahiparimarjana Chikitsa, Sthanika Shoola, Vyadhijanya Shoola, Vegadharanajanya Shoola.

Vulvar Pruritus: A Review of Clinical Associations, Pathophysiology and Therapeutic Management

Vulvar pruritus is an unpleasant sensation and frequent symptom associated with many dermatologic conditions, including infectious, inflammatory and neoplastic dermatoses affecting the female genitalia. It can lead to serious impairment of quality of life, impacting sexual function, relationships, sleep and self-esteem. In this review, common conditions associated with vulvar itch are discussed including atopic and contact dermatitis, lichen sclerosus, psoriasis and infectious vulvovaginitis. We review the potential physiologic, environmental and infectious factors that contribute to the development of vulvar itch and emphasize the importance of addressing their complex interplay when managing this disruptive and challenging symptom.

PAIN MANAGEMENT IN PRIMARY DYSMENORRHOEA AND ENDOMETRIOSIS- AYURVEDIC PERSPECTIVE

Pain is generally described as an unpleasant sensation and a universally understood sign of disease. Around 80% of women experience pain during periods from adolescent period right up to menopause. Dysmenorrhoea literally means painful menstruation. Primary dysmenorrhoea is one where there is no identifiable pelvic pathology. The pain begins a few hours before or just with the onset of menstruation and lasts for 24-48 hours. Secondary dysmenorrhoea is normally considered to be menstruation –associated pain occurring in the presence of pelvic pathology. Pain starts 7-8 days before menstruation. Endometriosis is one of the main causes of secondary dysmenorrhoea. Dysmenorrhoea can be correlated to Udavarta and endometriosis to Vatiki. In Udavarta, Sanga and Vimargagamana of Vata and derangement of Kapha pitta is responsible for pain. In Vatiki there is Apana vata vimargagamana, Vyana vata and Pitta vitiation causes Artava dusti and Dusta artava sthana samsraya in Kha vaigunya sites. So administration of drugs and treatment modalities crackling these factors involved in the etiopathogenesis do the work. Ayurvedic classic textbook along with available modern literatures were referred to make a clear view regarding the concept of pain and the main Yonirogas causing pain during menstruation and its management.

Dynamic Analysis of Human Brain in the Pain State by Electroencephalography

Objective Pain is an unpleasant sensation that is important in all therapeutic conditions. So far, some studies have focused on pain assessment and cognition through different tests and methods. Considering the occurrence of pain causes, along with the activation of a long network in brain regions, recognizing the dynamical changes of the brain in pain states is helpful for pain detection using the electroencephalogram (EEG) signal. Therefore, the present study addressed the above-mentioned issue by applying EEG at the time of inducing phasic pain. Results Phasic pain was produced using coldness and then dynamical features via EEG were analyzed by the Recurrence Quantification Analysis (RQA) method, and finally, the Rough neural network classifier was utilized for achieving accuracy regarding detecting and categorizing pain and non-pain states, which was 95.25\(\pm\)4%. The simulation results confirmed that cerebral behaviors are detectable during pain. In addition, the high accuracy of the classifier for evaluating the dynamical features of the brain during pain occurrence is one of the most merits of the proposed method. Eventually, pain detection can improve medical methods.

Cellular, Circuit and Transcriptional Framework for Modulation of Itch in the Central Amygdala

Itch is an unpleasant sensation that elicits robust scratching and active avoidance. However, the identity of the cells and neural circuits that organize this information remains elusive. Here we show the necessity and sufficiency of itch-activated neurons in the central amygdala (CeA) for both itch sensation and active avoidance. Further, we show that itch-activated CeA neurons play important roles in itch-related comorbidities, including anxiety-like behaviors, but not in some aversive and appetitive behaviors previously ascribed to CeA neurons. RNA-sequencing of itch-activated CeA neurons identified several differentially expressed genes as well as potential key signaling pathways in regulating pruritis. Finally, viral tracing experiments demonstrate that these neurons send a critical projection to the periaqueductal gray to mediate modulation of itch. These findings reveal a cellular and circuit signature of CeA neurons orchestrating behavioral and affective responses to pruritus in mice.

Molecular Aspects of Pruritus Pathogenesis in Psoriasis

Psoriasis is a chronic, systemic inflammatory disease with a genetic background that involves almost 3% of the general population worldwide. Approximately, 70–90% of patients with psoriasis suffer from pruritus, an unpleasant sensation that provokes a desire to scratch. Despite the enormous progress in understanding the mechanisms that cause psoriasis, the pathogenesis of psoriasis-related pruritus still remains unclear. In order to improve patients’ quality of life, development of more effective and safer antipruritic therapies is necessary. In turn to make it possible, better understanding of complexed and multifactorial pathogenesis of this symptom is needed. In this article we have systematized the current knowledge about pruritus origin in psoriasis.

Intrinsic braking role of descending locus coeruleus noradrenergic neurons in acute and chronic itch in mice

Itch is defined as an unpleasant sensation that provokes a desire to scratch. Our understanding of neuronal circuits for itch information transmission and processing in the spinal dorsal horn (SDH) has progressively advanced following the identification of SDH neuron subsets that are crucial for scratching behavior in models of itch. However, little is known about the control of acute and chronic itch by descending signals from the brain to the SDH. In this study, using genetic approaches that enable cell-type and circuit-specific functional manipulation, we reveal an intrinsic potential of locus coeruleus (LC)-noradrenergic (NAergic) neurons that project to the SDH to control acute and chronic itch. Activation and silencing of SDH-projecting LC-NAergic neurons reduced and enhanced scratching behavior, respectively, in models of histamine-dependent and -independent acute itch. Furthermore, in a model of chronic itch associated with contact dermatitis, repetitive scratching behavior was suppressed by the activation of the descending LC-NAergic pathway and by knocking out NA transporters specific to descending LC-NAergic neurons using a CRISPR-Cas9 system. Moreover, patch-clamp recording using spinal slices showed that noradrenaline facilitated inhibitory synaptic inputs onto gastrin-releasing peptide receptor-expressing SDH neurons, a neuronal subset known to be essential for itch transmission. Our findings suggest that descending LC-NAergic signaling intrinsically controls acute and chronic itch and provide potential therapeutic strategies for the treatment of acute and chronic itch.