A clinical approach of neuropathic pain in piriformis syndrome: case presentation and rehabilitation particularities

Piriformis syndrome is a rare cause of sciatica and buttock pain and is usually considered as a diagnosis of exclusion for patients with a history of trauma. It usually presents without abnormalities regarding sensory and motor functions and tends to have a favorable evolution with pharmacological treatment. We present the case of a patient with posttraumatic piriformis syndrome who came to our department with significant pain and muscle weakness. The diagnosis was confirmed using clinical tests, imaging techniques and electroneurography. The patient did not respond to pharmacologic treatment alone and therefore surgery was performed. Surgery along with pharmacological treatment, complementary pain treatment and physical rehabilitation provided a favorable outcome. Keywords: neurology, rehabilitation, piriformis syndrome, deep gluteal syndrome, traumatic neuropathy, neuropathic pain,

Dorsal Root Ganglion Stimulation Alleviates Pain-related Behaviors in Rats with Nerve Injury and Osteoarthritis

Background Dorsal root ganglion field stimulation is an analgesic neuromodulation approach in use clinically, but its mechanism is unknown as there is no validated animal model for this purpose. The authors hypothesized that ganglion stimulation is effective in reducing pain-like behaviors in preclinical chronic pain models. Methods The authors provided ganglion stimulation or spinal cord stimulation to rats with traumatic neuropathy (tibial nerve injury), or osteoarthritis induced by intraarticular knee monosodium iodoacetate, or without injury (naïve). Analgesia was evaluated by testing a battery of pain-related reflexive, functional, and affective behaviors. Results In rats with nerve injury, multilevel L4 and L5 ganglion stimulation decreased hypersensitivity to noxious mechanical stimulation more (area under curve, −1,447 ± 423 min × % response; n = 12) than single level ganglion stimulation at L4 ([−960 ± 251 min × % response; n = 8; P = 0.012] vs. L4 and L5), and L5 ([−676 ± 295 min × % response; n = 8; P < 0.0001] vs. L4 and L5). Spontaneous pain-like behavior, evaluated by conditioned place preference, responded to single L4 (Pretest [−93 ± 65 s] vs. Test [87 ± 82 s]; P = 0.002; n = 9), L5 (Pretest [−57 ± 36 s] vs. Test [137 ± 73 s]; P = 0.001; n = 8), and multilevel L4 and L5 (Pretest: −81 ± 68 s vs. Test: 90 ± 76 s; P = 0.003; n = 8) ganglion stimulation. In rats with osteoarthritis, multilevel L3 and L4 ganglion stimulation reduced sensitivity to knee motion more (−156 ± 28 min × points; n = 8) than L3 ([−94 ± 19 min × points in knee bend test; n = 7; P = 0.002] vs. L3 and L4) or L4 ([−71 ± 22 min × points; n = 7; P < 0.0001] vs. L3 and L4). Conditioned place preference during osteoarthritis revealed analgesic effectiveness for ganglion stimulation when delivered at L3 (Pretest [−78 ± 77 s] vs. Test [68 ± 136 s]; P = 0.048; n = 9), L4 (Pretest [−96 ± 51 s] vs. Test [73 ± 111 s]; P = 0.004; n = 9), and L3 and L4 (Pretest [−69 ± 52 s; n = 7] vs. Test [55 ± 140 s]; P = 0.022; n = 7). Conclusions Dorsal root ganglion stimulation is effective in neuropathic and osteoarthritic preclinical rat pain models with peripheral pathologic origins, demonstrating effectiveness of ganglion stimulation in a placebo-free setting and justifying this model as a suitable platform for mechanistic studies. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

Results clinical assessment of the application of nonsteroidal anti-inflammatory drugs for pain symptoms occurring after endodontic dental treatment

Pain is one of the most common and most difficult on subjective perception of dental symptoms. These domestic and foreign literature stating a fact that more than 80% of patients after endodontic treatment there is a feeling «fullness» in the tooth, pain when biting on the tooth, radiating to neighboring teeth or along the branches of the trigeminal nerve. From the pathogenesis point of view, the above manifestations are acute toxic-traumatic neuropathy of the trigeminal nerve. This often leads to an unreasonable removal of a qualitatively and competently cured tooth. A comparison was made of the analgesic activity of ketanov in the relief of pain that occurs after root canal filling, with the analgesic activity of nimesulide in 57 patients aged 20 to 55 years. In acute pain, an analgesic effect with the administration of ketanov appeared within 15 to 20 minutes, with the administration of nimesil, the effect occurred within 30-40 minutes. After a course of treatment, patients in both groups significantly decreased irritability, sleep normalized. Patients believed in the success of treatment, because a decrease or a significant decrease in the pain syndrome reflexively leads to an improvement in the psycho-emotional sphere of patients, which in turn favors long-term remission.