Do chronic pain syndromes in lower limb amputees have an effect on the use of prostheses?

BACKGROUND: The use of a prosthesis is critical to regain the ability to walk in lower limb amputees but the relationship between the use of a prosthesis and chronic pain syndromes (PLS, PLP, RLP), common in amputees patients, is still poorly understood. OBJECTIVE: This long-term follow-up study investigates the possible correlation between prosthesis use and the presence of PLP, PLS and RLP in lower limb amputees. METHODS: Patients undergoing transtibial, transfemoral or hemipelvectomy amputation of any aetiology at the Rizzoli Orthopaedic Institute from 2008 to 2018 were included. The Houghton scale was used to assess functional use of the prosthesis. RESULTS: The results show that, in lower limb amputees, prosthesis use is greater in individuals with below-the-knee amputation and in those who were younger at the time of amputation. No significant correlation between the presence of pain syndromes (PLS, PLP, RLP) and the various items on the Houghton scale was found. CONCLUSIONS: The study found no significant correlation indicating that phantom limb pain syndromes affect amputee use of a prosthesis.

Low-Dose Naltrexone Use for Patients with Chronic Regional Pain Syndrome: A Systematic Literature Review

BACKGROUND: Complex regional pain syndrome is a rare, neuropathic disorder that affects fewer than 200,000 individuals in the United States annually. Current treatments often focus on pain management and fall short of relieving symptoms of pain and dystonia in patients. OBJECTIVE: The goal of this systematic qualitative review is to evaluate the evidence for the use of low-dose naltrexone in the treatment of chronic pain syndromes. STUDY DESIGN: This is a systematic review. METHODS: PubMed, Embase, and Web of Science were searched for articles containing the keywords “low-dose naltrexone” AND (“pain” OR “chronic pain” OR “fibromyalgia” OR “complex regional pain syndrome” OR “neuropathic pain” OR “nociceptive pain”) between 1950 and July 17, 2020. A total of 30 publications were systematically reviewed. Exclusion criteria were articles that were unavailable in English, focused on acute pain only, and evaluated only animal models. Case studies were included for the purposes of our qualitative review. RESULTS: Out of 29 articles, we reviewed 11 prospective studies, 10 case studies, 3 systematic reviews, 2 retrospective studies, 2 simulation models, and one combination study. Articles focused on chronic pain syndromes as well as painful rheumatologic disorders and neurological disorders. We found that low-dose naltrexone treatment was positively associated with symptom relief in patients experiencing chronic pain, dystonia, and sleep disturbances. LIMITATIONS: Due to the limited number of available articles focusing on the treatment of complex regional pain syndrome with low-dose naltrexone, the majority of studies analyzed focused on other chronic pain syndromes. CONCLUSIONS: There is a need for additional prospective and interventional studies addressing the use of low-dose naltrexone in the treatment of complex regional pain syndrome symptoms. KEY WORDS: Complex regional pain syndrome, reflex sympathetic dystrophy, low-dose naltrexone, chronic pain, opioid antagonist

P124 Are chronic pain syndromes associated with a unique cytokine profile? A systematic review and meta-analysis

Background/Aims The aetiology of primary chronic pain syndromes (CPS) is highly disputed. One theory suggests that pain is due to a pro-inflammatory cytokine milieu leading to nociceptive activation. We performed a systematic review and meta-analysis aiming to assess differences in cytokines levels in CPS patients versus healthy controls (HC). Methods Human studies published in English from PubMed, MEDLINE/Scopus and Cochrane databases were searched from inception up to January 2020. We included full text cross-sectional or longitudinal studies with cytokine measurements in CPS patients and HC. We excluded studies with underlying organic pathology. Quality assessment was completed using a modified version of the Newcastle-Ottawa Scale. Random-effects meta-analysis models were used to report pooled effects and 95% CIs. Study registered with PROSPERO (CRD42020193774). Results Initial search yielded 324 papers, 36 studies (3229 participants) eligible for systematic review and 26 studies (2048 participants) suitable for metaanalysis. There were reproducible findings supporting trends of cytokine levels comparing CPS patients with HC. Eotaxin (chemokine) however was consistently raised in CPS. Meta-analysis showed significantly increased tumour necrosis factor (TNF) (SMD=0.39, p = 0.0009, %95I=0.16-0.63, p < 0.001; I2=70%, Q2 p < 0.001), interleukin (IL)-6 (SMD=0.15, 8 (SMD=0.26, p = 0.01, 95%CI =0.05-0.47; I2=61%, Q2 p = 0.005) and IL-10 (SMD=0.61; %95 = 0.34-0.89, p < 0.001; I2 = 10%, Q2 p = 0.34) in CPS compared to HC. Conclusion We found significant differences in peripheral blood cytokine profiles of CPS patients compared to HC. However, the distinctive profile associated with CPS includes both pro-inflammatory (TNF-α, IL-6, IL-8), and anti-inflammatory cytokines (IL-10) in pooled analysis, as well as chemokine (eotaxin) signatures. Disclosure L. Furtado O'Mahony: None. A. Srivastava: None. P. Mehta: None. C. Ciurtin: None.

Transcriptional and cellular signatures of cortical morphometric similarity remodelling in chronic pain

Chronic pain is a highly debilitating and poorly understood condition. Here, we attempt to advance our understanding of the brain mechanisms driving chronic pain by investigating alterations in morphometric similarity (MS) and corresponding transcriptomic and cellular signatures, in three cohorts of patients with distinct chronic pain syndromes (knee osteoarthritis, low back pain and fibromyalgia). We uncover a novel pattern of cortical MS remodelling involving mostly MS increases in the insula and limbic cortex, which cuts across the boundaries of specific pain syndromes. We show that cortical MS remodelling in chronic pain spatially correlates with the brain-wide expression of genes involved in the glial immune response and neuronal plasticity. Cortical remodelling in chronic pain might involve a disruption of multiple elements of the cellular architecture of the brain. Therefore, multi-target therapeutic approaches tackling both glial activation and neuronal hyperexcitability might better encompass the full neurobiology of chronic pain.

LOWER URINARY TRACT SYNDROME IN ELDERLY AND SENILE PEOPLE WITH COMBINED PATHOLOGY OF THE PROSTATE AND LUMBAR SPINE

Для определения места и роли дегенеративных изменений поясничного отдела позвоночника в патогенезе синдрома нижних мочевых путей и успешности проведения лечебных мер наблюдали 106 мужчин пожилого и старческого возраста, страдающих доброкачественной гиперплазией предстательной железы и патологией позвоночника. Длительные хронические боли в пояснице испытывали 48 (45,3 %) пациентов, у 93,8 % из них отмечали никтурию, у 75 % - затруднения при мочеиспускании, у 60,4 % - ложные позывы на мочеиспускание, что мотивировало обращение к урологу. Выявленные с помощью опросника IPSS различия, соответственно 21,78±4,33 и 16,33±4,61 балла, указывали на негативное значение хронического болевого синдрома в формировании общей клинической картины урологической патологии. У лиц старческого возраста болевой синдром и симптомы раздражения мочевых путей были менее выраженными, чем у лиц пожилого возраста, а обструктивные симптомы, наоборот, более отчетливыми. Хронические болевые синдромы в поясничной области значительно чаще ( р <0,001)регистрировали у 67 пациентов с удовлетворительными и неудовлетворительными результатами лечения по поводу расстройств мочеиспускания, чем у 39 с наилучшей эффективностью. Таким образом, патология поясничного отдела позвоночника и связанные с ней хронические болевые синдромы вносят существенный вклад в патогенез и клиническую картину синдрома нижних мочевых путей и в результативность лечения расстройств мочеиспускания. Выявленные особенности следует учитывать в процессе диагностики и лечения комбинированной патологии. In order to determine the place and role of degenerative changes in the lumbar spine in the pathogenesis of lower urinary tract syndrome and the success of treatment measures, 106 elderly and senile male patients suffering from benign prostatic hyperplasia and spinal pathology were observed. Long-term chronic lower back pain was experienced by 48 (45,3 %) patients, 93,8 % of them had night urination, 75 % had difficulty urinating, and 60,4 % had false urge to urinate, which motivated them to contact a urologist.The differences identified using the IPSS questionnaire, respectively 21,78±4,33 and 16,33±4,61 points, indicated a negative value of chronic pain syndrome in the formation of the overall clinical picture of urological pathology. Among the senile patients, pain and urinary tract irritation symptoms were less pronounced than among the elderly patients, and obstructive symptoms, on the contrary, were more pronounced. Chronic pain syndromes in the lumbar region were significantly more frequent ( p <0,001) among 67 patients with satisfactory and unsatisfactory results of treatment for urination disorders than among 39 with the best efficiency. Thus, the pathology of the lumbar spine and associated chronic pain syndromes make a significant contribution to the pathogenesis and clinical picture of the lower urinary tract syndrome and to the effectiveness of treatment of urination disorders. The identified features should be taken into account in the process of diagnosis and treatment of combined pathology.