Peripheral neuropathy is a common and severe dose-limiting side effect of the chemotherapy agent, bortezomib, in multiple myeloma patients. Treatment with narcotics, antidepressants, and anticonvulsants has limited response and potential significant side effects. Acupuncture has been reported to be effective in treating diabetic neuropathy and chemo-induced peripheral neuropathy. There has not been report on the effect of acupuncture in treating bortezomib-induced peripheral neuropathy specifically. Here, we report a successful case of using acupuncture to relieve bortezomib-induced peripheral neuropathy symptoms.

Ting Bao

Ruixin Zhang

Ashraf Badros

Lixing Lao

Acupuncture Treatment for Bortezomib-Induced Peripheral Neuropathy: A Case Report


		570 patients with acute ankle joint distortion were randomized to four treatment groups: a combination spray of arnica tincture and hydroxyethyl salicylate (HES; group A, <svg style="vertical-align:-0.1575pt;width:45.487499px;" id="M1" height="9.7875004" version="1.1" viewBox="0 0 45.487499 9.7875004" width="45.487499" xmlns="http://www.w3.org/2000/svg">
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			</svg>), arnica (B, <svg style="vertical-align:-0.1575pt;width:38.474998px;" id="M2" height="9.9624996" version="1.1" viewBox="0 0 38.474998 9.9624996" width="38.474998" xmlns="http://www.w3.org/2000/svg">
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			</svg>), and placebo (D, <svg style="vertical-align:-0.1575pt;width:38.474998px;" id="M4" height="9.9624996" version="1.1" viewBox="0 0 38.474998 9.9624996" width="38.474998" xmlns="http://www.w3.org/2000/svg">
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			</svg>). The medication was applied 4-5 times daily for 10 days. Efficacy was assessed on day 3-4 by evaluating pain on motion on a visual analogue scale (VAS). 
Pain improvement in group A was significantly superior over groups B&#x2013;D (<svg style="vertical-align:-0.10126pt;width:4.5124998px;" id="M5" height="8.1999998" version="1.1" viewBox="0 0 4.5124998 8.1999998" width="4.5124998" xmlns="http://www.w3.org/2000/svg">
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			</svg>-test with unadjusted baseline values, <svg style="vertical-align:-0.28125pt;width:74.275002px;" id="M6" height="12.7625" version="1.1" viewBox="0 0 74.275002 12.7625" width="74.275002" xmlns="http://www.w3.org/2000/svg">
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			</svg> and ANCOVA after adjustment, <svg style="vertical-align:-0.28125pt;width:79.1875px;" id="M7" height="12.9" version="1.1" viewBox="0 0 79.1875 12.9" width="79.1875" xmlns="http://www.w3.org/2000/svg">
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			</svg>) and approximately corresponded to the cumulative effect of the single constituents (12.1, 7.5, and 18.7&#x2009;mm VAS for A versus B, A versus C, and A versus D; 95&#x25; CI 8.0&#x2013;16.2, 4.7&#x2013;10.4, and 14.8&#x2013;22.5&#x2009;mm). The combination is justified by the additive effects of the single active constituents.

Miroslav Ku&#269;era

Pavel Kolar

Milos Barna

Alexander Ku&#269;era

Marie Hladikov&#225;

Arnica/Hydroxyethyl Salicylate Combination Spray for Ankle Distortion: A Four-Arm Randomised Double-Blind Study

<i>Objective</i>. This pilot study clinically tests whether a conversion factor of 2 to 1 is appropriate when changing from oral to parenteral morphine administration in the treatment of cancer-related nociceptive pain and calculates the size of an adequately powered future study. <i>Methods</i>. Eleven outpatients with incurable cancer and well-controlled nociceptive pain were randomly assigned to either intravenous or subcutaneous morphine using half the previous oral 24-hour dose. Each group crossed over after the first three-day period. Serum concentrations of morphine and its metabolites were monitored as well as intensity of pain. <i>Results</i>. Oral to subcutaneous and oral to intravenous quotas of morphine concentrations were approximately 0.9. Subcutaneous to intravenous morphine quotas were 1. <i>Conclusions</i>. The conversion factor of 2 to 1 seems to be a reasonable average but with an obvious need for individual adjustments. Concurrent medications and substantially higher doses of morphine could potentially affect the appropriate conversion factor. An adequately powered study to validate these findings would need at least 121 patients.

Jan Starlander

Christina Melin-Johansson

H&#229;kan Jonsson

Bertil Axelsson

Oral-Parenteral Conversion Factor for Morphine in Palliative Cancer Care: A Prospective Randomized Crossover Pilot Study

Patients experiencing lower body pain resulting from bone metastases have greater levels of functional interference than those with upper body pain. The purpose of this study was to assess the levels of interference caused by pain after treatment with conventional radiotherapy using the Brief Pain Inventory (BPI) and to validate this tool for telephone use. After radiotherapy, a total of 159, 129, and 106 patients completed the BPI over the telephone at months 1, 2, and 3, respectively. Cronbach&#39;s alpha, confirmatory factor analysis, and discriminant validity tests were performed to assess the validity of the BPI. One-way ANOVA was used to compare BPI scores. There was no statistically significant difference in functional interference among patients after treatment. Internal consistency of the BPI was high. Functional interference may be inherently higher in patients with pain in the lower body. Telephone use of the BPI is reliable and recommended in this population.

Liang Zeng

Arjun Sahgal

Liying Zhang

Kaitlin Koo

Lori Holden

Florencia Jon

May Tsao

Elizabeth Barnes

Cyril Danjoux

Kristopher Dennis

Luluel Khan

Edward Chow

Patterns of Pain and Functional Improvement in Patients with Bone Metastases after Conventional External Beam Radiotherapy and a Telephone Validation Study

This study evaluated relationships between irritable bowel syndrome (IBS) pain, sympathetic dysregulation, and thermal pain sensitivity.  Eight female patients with diarrhea-predominant IBS and ten healthy female controls were tested for sensitivity to thermal stimulation of the left palm.  A new method of response-dependent thermal stimulation was used to maintain pain intensity at a predetermined level (35&#x25;) by adjusting thermal stimulus intensity as a function of pain ratings.  Clinical pain levels were assessed prior to each testing session.  Skin temperatures were recorded before and after pain sensitivity testing.  The temperature of palmar skin dropped (1.5<svg style="vertical-align:-0.17554pt;width:15px;" id="M1" height="10.9125" version="1.1" viewBox="0 0 15 10.9125" width="15"  xmlns="http://www.w3.org/2000/svg">
	<g transform="matrix(1.25,0,0,-1.25,0,10.9125)">
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				<tspan style="font-size: 8.75px; " x="0" y="0">∘</tspan>
			</text>

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		</g>
	</g>
</svg>) when the corresponding location on the opposite hand of control subjects was subjected to prolonged thermal stimulation, but this response was absent for IBS pain patients. The patients also required significantly lower stimulus temperatures than controls to maintain a 35&#x25; pain rating.  Baseline skin temperatures of patients were significantly correlated with thermode temperatures required to maintain 35&#x25; pain ratings.  IBS pain intensity was not significantly correlated with skin temperature or pain sensitivity. The method of response-dependent stimulation revealed thermal hyperalgesia and increased sympathetic tone for chronic pain patients, relative to controls.  Similarly, a significant correlation between resting skin temperatures and thermal pain sensitivity for IBS but not control subjects indicates that tonic sympathetic activation and a thermal hyperalgesia were generated by the chronic presence of visceral pain.  However, lack of a significant relationship between sympathetic tone and ratings of IBS pain casts doubt on propositions that the magnitude of IBS pain is determined by psychological stress.

Fong Wong

Anthony C. Rodrigues

Christopher D. King

Joseph L. Riley

Siegfried Schmidt

Charles J. Vierck

Andre P. Mauderli

Relationships between Irritable Bowel Syndrome Pain, Skin Temperature Indices of Autonomic Dysregulation, and Sensitivity to Thermal Cutaneous Stimulation

<i>Objective</i>. To report our successful treatment of acute symptoms of posttraumatic stress disorder (PTSD). By the use of stellate ganglion block (SGB) and pulsed radiofrequency (PRF) to the stellate ganglion(SG) , sequentially. <i>Background</i>. A 48-year-old male a  victim
of armed robbery , who presented with extreme symptoms consistent with the diagnosis of  PTSD. He was treated with antianxiety medications, as well as psychotherapy, but his symptoms persisted.
 <i>Methods</i>. Fifty-five days post trauma, we administered a SGB to the patient. One month later, we administered  PRF to the right SG . We repeated the pulsed radiofrequency 30 weeks post trauma and performed a second SGB two weeks after that.  <i>Results</i>. After the SGB , the patient experienced a major reduction in anxiety. Over the next week his improved allowing a  significant reduction of antianxiety medications. One month later the symptoms returned and again subsided substantially  following PRF , and that relief lasted four months. The patient than required another following PRF and a SGB with good responses. <i>Conclusion</i>. We report that selective blockade of the stellate ganglion via injection and the treatment with PRF, relieved our patient&#39;s symptoms of PTSD. And we also provide a plausible explanation of the effect.

Eugene Lipov

Successful Use of Stellate Ganglion Block and Pulsed Radiofrequency in the Treatment of Posttraumatic Stress Disorder: A Case Report

The role of affective dimension in the postoperative pain is still poorly understood. The present study investigated the development of anxiety-like behavior and amygdala sensitization in incisional pain. Using hind-paw incision model in rats, we showed that surgical incision induced the anxiety-like behavior as determined by elevated plus-maze and open-field tests. Intraperitoneal (IP) morphine administration reversed mechanical allodynia and anxiety-like behavior in a dose-dependent manner. Gabapentin also partially reduced incision-evoked mechanical allodynia and anxiety-like behavior in a dose-dependent manner. After incision, the expression of phosphorylated cAMP response elements (CRE-) binding protein (p-CREB) was transiently upregulated in the central and basolateral nuclei in the bilateral amygdala. The upregulation of p-CREB was inhibited by morphine and gabapentin. The present study suggested that surgical incision could induce anxiety and amygdala sensitization that can be inhibited by morphine and gabapentin. Thus treatment of surgery-induced affective disturbances by morphine and gabapentin may be a potential important adjunct therapy in the postoperative pain management.

Chang-Qi Li

Jian-Wei Zhang

Ru-Ping Dai

Juan Wang

Xue-Gang Luo

Xin-Fu Zhou

Surgical Incision Induces Anxiety-Like Behavior and Amygdala Sensitization: Effects of Morphine and Gabapentin

During the course of a psychophysical study of fibromyalgia syndrome (FMS), one of the subjects with a long history of headache and facial pain displayed an extraordinarily severe thermal allodynia. Her stimulus-response function for ratings of cutaneous heat pain revealed a sensitivity clearly beyond that of normal controls and most FMS subjects. Specially designed psychophysical methods showed that heat sensitivity sometimes increased dramatically within a series of stimuli. Prior exposure to moderate heat pain served as a trigger for allodynic ratings of series of normally neutral thermal stimulation. These observations document a case of breakthrough pain sensitivity with implications for mechanisms of FMS pain.

Anthony Rodrigues

Extreme Thermal Sensitivity and Pain-Induced Sensitization in a Fibromyalgia Patient

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