Pretreatment of emulational manual acupuncture versus electroacupuncture against visceral traction pain in rats

BACKGROUND： Acupuncture and moxibustion against visceral noxious stimulation present different mechanisms in the peripheral and central nervous systems, involving release of neurotransmitter substance P, acetylcholine esterase, leucine-enkephalin, and c-Fos protein expression. However, there are few reports addressing changes in neurotransmitter expression following manual acupuncture and electroacupuncture against visceral traction pain.OBJECTIVE： To explore changes in neurotransmitter expression in the ileum and protein expression in the medullary visceral zone of visceral traction pain rats undergoing pretreatment of emulational manual acupuncture, and to investigate the differences between emulational manual acupuncture and electroacupuncture.DESIGN, TIME AND SETTING： The randomized, controlled study was performed at the Biomedical Engineering Laboratory, Shanghai University of Traditional Chinese Medicine, Shanghai, China from August 2008 to July 2009.MATERIALS： G6805 electroacupuncture apparatus （Shanghai Medical Electronic Machine Factory, China） and ZSF-I acupuncture manipulation simulation therapeutic system （Chinese Medical Engineering Room, Shanghai University of Traditional Chinese Medicine, Shanghai China） were used in the present study.METHODS： A total of 40 male Sprague Dawley rats were equally and randomly assigned to sham surgery, model, emulational manual acupuncture and electroacupuncture groups. In the emulational manual acupuncture and electroacupuncture groups, emulational manual acupuncture and electroacupuncture were applied at bilateral Zusanli （ST 36） acupoints for 30 minutes, and models of visceral traction pain were established immediately.MAIN OUTCOME MEASURES： Substance P expression, c-Fos and glial fibrillary acidic protein expression were measured using immunohistochemistry. Acetylcholine esterase activity was examined utilizing a colorimetric method. Leucine-enkephalin content was detected using a radioimmune assay. Degree of pain in rats was assessed by pain score.RESULTS： Pain score, substance P expression in the ileum, acetylcholine esterase activity, expression of c-Fos protein and glial fibrillary acidic protein in the medullary visceral zone were significantly decreased following pretreatment of emulational manual acupuncture and electroacupuncture in rats with visceral traction pain （P〈0.05）. Compared with the electroacupuncture group, the leucine-enkephalin content was significantly increased, and pain score was significantly diminished in the emulational manual acupuncture group （P〈0.05）.CONCLUSION： Emulational manual acupuncture pretreatment decreases acetylcholine esterase activity, increases leucine-enkephalin release, downregulates expression of c-Fos protein and glial fibrillary acidic protein and ultimately inhibits visceral traction pain by reducing substance P release. The effectiveness in inhibiting visceral traction pain is greater when using emulational manual acupuncture compared with electroacupuncture. This is because emulational manual acupuncture effectively increases leucine-enkephalin release.

Serotonin receptor 2B induces visceral hyperalgesia in rat model and patients with diarrhea-predominant irritable bowel syndrome

BACKGROUND Serotonin receptor 2B(5-HT2B receptor)plays a critical role in many chronic pain conditions.The possible involvement of the 5-HT2B receptor in the altered gut sensation of irritable bowel syndrome with diarrhea(IBS-D)was investigated in the present study.AIM To investigate the possible involvement of 5-HT2B receptor in the altered gut sensation in rat model and patients with IBS-D.METHODS Rectosigmoid biopsies were collected from 18 patients with IBS-D and 10 patients with irritable bowel syndrome with constipation who fulfilled the Rome IV criteria and 15 healthy controls.The expression level of the 5-HT2B receptor in colon tissue was measured using an enzyme-linked immunosorbent assay and correlated with abdominal pain scores.The IBS-D rat model was induced by intracolonic instillation of acetic acid and wrap restraint.Alterations in visceral sensitivity and 5-HT2B receptor and transient receptor potential vanilloid type 1(TRPV1)expression were examined following 5-HT2B receptor antagonist adminis-tration.Changes in visceral sensitivity after administration of the TRPV1 antago-INTRODUCTION Irritable bowel syndrome(IBS)is a chronic functional bowel disorder characterized by recurrent abdominal pain with altered bowel habits that affects approximately 15%of the population worldwide[1].IBS significantly impacts the quality of life of patients.Although the pathogenesis of IBS is not completely understood,the role of abnormal visceral sensitivity in IBS has recently emerged[2,3].5-Hydroxytryptamine(5-HT)is known to play a key role in the physiological states of the gastrointestinal tract.Plasma 5-HT levels in IBS with diarrhea(IBS-D)patients were greater than those in healthy controls[4],suggesting a possible role of 5-HT in the pathogenesis of IBS-D.The serotonin receptor 2(5-HT2 receptor)family comprises three subtypes:5-HT2A,5-HT2B,and 5-HT2c.All 5-HT2 receptors exhibit 46%-50%overall sequence identity,and all of these receptors preferentially bind to Gq/11 to increase inositol phosphates and intracellular calcium mobilization[5].5-HT2B receptors are widely expressed throughout the gut,and experimental evidence suggests that the primary function of 5-HT2B receptors is to mediate contractile responses to 5-HT through its action on smooth muscle[6].The 5-HT2B receptor is localized to both neurons of the myenteric nerve plexus and smooth muscle in the human colon.The 5-HT2B receptor mediates 5-HT-evoked contraction of longitudinal smooth muscle[6].These findings suggest that the 5-HT2B receptor could play an important role in modulating colonic motility,which could affect sensory signaling in the gut.Other laboratories have shown that the 5-HT2B receptor participates in the development of mechanical and formalin-induced hyperalgesia[7,8].A 5-HT2B receptor antagonist reduced 2,4,6-trinitrobenzene sulfonic acid(TNBS)and stress-induced visceral hyperalgesia in rats[9,10].However,the role of the 5-HT2B receptor in IBS-D patients and in acetic acid-and wrap restraint-induced IBS-D rat models was not investigated.

Effect of Preemptive Ketamine Administration on Postoperative Visceral Pain after Gynecological Laparoscopic Surgery

The pain following gynecological laparoscopic surgery is less intense than that following open surgery; however, patients often experience visceral pain after the former surgery. The aim of this study was to determine the effects of preemptive ketamine on visceral pain in patients undergoing gynecological laparoscopic surgery. Ninety patients undergoing gynecological laparoscopic surgery were randomly assigned to one of three groups. Group 1 received placebo. Group 2 was intravenously injected with preincisional saline and local infiltration with 20 m L ropivacaine（4 mg/m L） at the end of surgery. Group 3 was intravenously injected with preincisional ketamine（0.3 mg/kg） and local infiltration with 20 m L ropivacaine（4 mg/m L） at the end of surgery. A standard anesthetic was used for all patients, and meperidine was used for postoperative analgesia. The visual analogue scale（VAS） scores for incisional and visceral pain at 2, 6, 12, and 24 h, cumulative analgesic consumption and time until first analgesic medication request, and adverse effects were recorded postoperatively. The VAS scores of visceral pain in group 3 were significantly lower than those in group 2 and group 1 at 2 h and 6 h postoperatively（P〈0.05 and P〈0.01, respectively）. At 2 h and 6 h, the VAS scores of incisional pain did not differ significantly between groups 2 and 3, but they were significantly lower than those in group 1（P〈0.01）. Groups 1 and 2 did not show any differences in visceral pain scores at 2 h and 6 h postoperatively. Moreover, the three groups showed no statistically significant differences in visceral and incisional pain scores at 12 h and 24 h postoperatively. The consumption of analgesics was significantly greater in group 1 than in groups 2 and 3, and the time to first request for analgesics was significantly longer in groups 2 and 3 than in group 1, with no statistically significant difference between groups 2 and 3. However, the three groups showed no significant difference in the incidence of shoulder pain or adverse effects. Preemptive ketamine may reduce visceral pain in patients undergoing gynecological laparoscopic surgery.

Serotonin transporter and cholecystokinin in diarrhea-predominant irritable bowel syndrome: Associations with abdominal pain, visceral hypersensitivity and psychological performance

BACKGROUND Visceral hypersensitivity and psychological performance are the main pathophysiological mechanisms of irritable bowel syndrome(IBS).Previous studies have found that cholecystokinin(CCK)can enhance colon movement and that serotonin transporter(SERT)is a transmembrane transport protein with high affinity for 5-hydroxytryptamine,which can rapidly reuptake 5-hydroxytryptamine and then regulate its action time and intensity.We speculate that SERT and CCK might play a role in the pathogenesis of diarrheapredominant IBS(IBS-D)by affecting visceral sensitivity and the brain-gut axis.AIM To determine SERT and CCK levels in IBS-D patients diagnosed using Rome IV criteria and to analyze their associations with abdominal pain,visceral hypersensitivity and psychological performance.METHODS This study collected data from 40 patients with IBS-D at the China-Japan Friendship Hospital from September 2017 to April 2018 and 18 healthy controls.The severity of abdominal pain,visceral sensitivity and psychological performance were evaluated in IBS-D patients and healthy controls,the levels of SERT and CCK in plasma and colonic mucosa were evaluated,and the correlations between them were analyzed.RESULTS There were significant differences in the initial sensation threshold(31.00±8.41 mL vs 52.22±8.09 mL,P<0.001),defecating sensation threshold(51.75±13.57 mL vs 89.44±8.73 mL,P<0.001)and maximum tolerable threshold(97.25±23.64 mL vs 171.11±20.83 mL,P<0.001)between the two groups.IBS-D patients had more severe anxiety(7.78±2.62 vs 2.89±1.02,P<0.001)and depressive(6.38±2.43 vs 2.06±0.73,P<0.001)symptoms than healthy controls.Significant differences were also found in mucosal CCK(2.29±0.30 vs 1.66±0.17,P<0.001)and SERT(1.90±0.51 vs 3.03±0.23,P<0.001)between the two groups.There was a significant positive correlation between pain scores and mucosal CCK(r=0.96,0.93,0.94,P<0.001).Significant negative correlations between anxiety(r=-0.98;P<0.001),depression(r=-0.99;P<0.001),pain evaluation(r=-0.96,-0.93,-0.95,P<0.001)and mucosal SERT were observed.CONCLUSION IBS-D patients had psychosomatic disorders and visceral hypersensitivity.SERT and CCK might be involved in the pathogenesis of IBS-D by regulating the braingut axis and affecting visceral sensitivity.This provides a new potential method for identifying a more specific and effective therapeutic target.

Possible implications of animal models for the assessment of visceral pain

Acute pain,provoked generally after the activation of peripheral nociceptors,is an adaptive sensory function that alerts the individual to avoid noxious stimuli.However,uncontrolled acute pain has a maladaptive role in sensory activity leading to development of a chronic pain state which persists even after the damage is resolved,or in some cases,in the absence of an initial local acute injury.Huge numbers of people suffer from visceral pain at least once during their life span,leading to substantial health care costs.Although studies reporting on the mechanism of visceral pain are accumulating,it is still not precisely understood.Therefore,this review aims to elucidate the mechanism of visceral pain through an evaluation of different animal models and their application to develop novel therapeutic approaches for treating visceral pain.To assess the nociceptive responses in viscera,several visceral pain models such as inflammatory,traction,stress and genetic models utilizing different methods of measurement have been devised.Among them,the inflammatory and traction models are widely used for studying the visceral pain mechanism of different disease conditions and post-operative surgery in humans and animals.A hapten,2,4,6-trinitrobenzene sulfonic acid(TNBS),has been extensively used as an inflammatory agent to induce visceral pain.The traction model seems to cause a strong pain stimulation and autonomic reaction and could thus be the most appropriate model for studying the underlying visceral pain mechanism and for probing the therapeutic efficacies of various anesthetic and analgesics for the treatment of visceral pain and hyperalgesia.

Estrogen augmented visceral pain and colonic neuron modulation in a double-hit model of prenatal and adult stress

BACKGROUND Chronic stress during pregnancy may increase visceral hyperalgesia of offspring in a sex-dependent way.Combining adult stress in offspring will increase this sensitivity.Based on the evidence implicating estrogen in exacerbating visceral hypersensitivity in female rodents in preclinical models,we predicted that chronic prenatal stress(CPS)+chronic adult stress(CAS)will maximize visceral hyperalgesia;and that estrogen plays an important role in colonic hyperalgesia.AIM The aim was to illuminate the role of estrogen in colonic hyperalgesia and its underlying mechanisms.METHODS We established a CPS plus CAS rodent model in which the balloon was used to distend the colorectum.The single-fiber recording in vivo and patch clamp experiments in vitro were used to monitor the colonic neuron’s activity.The reverse transcription-polymerase chain reaction,western blot,and immunofluorescence were used to study the effects of CPS and CAS on colon primary afferent sensitivity.We used ovariectomy and letrozole to reduce estrogen levels of female rats respectively in order to assess the role of estrogen in female-specific enhanced primary afferent sensitization.RESULTS Spontaneous activity and single fiber activity were significantly greater in females than in males.The enhanced sensitization in female rats mainly came from lowthreshold neurons.CPS significantly increased single-unit afferent fiber activity in L6-S2 dorsal roots in response.Activity was further enhanced by CAS.In addition,the excitability of colon-projecting dorsal root ganglion(DRG)neurons increased in CPS+CAS rats and was associated with a decrease in transient Atype K+currents.Compared with ovariectomy,treatment with the aromatase inhibitor letrozole significantly reduced estrogen levels in female rats,confirming the gender difference.Moreover,mice treated with letrozole had decreased colonic DRG neuron excitability.The intrathecal infusion of estrogen increased brain-derived neurotrophic factor(BDNF)protein levels and contributed to the response to visceral pain.Western blotting showed that nerve growth factor protein was upregulated in CPS+CAS mice.CONCLUSION This study adds to the evidence that estrogen-dependent sensitization of primary afferent colon neurons is involved in the development of chronic stress-induced visceral hypersensitivity in female rats.

Establishment of model of visceral pain due to colorectal distension and its behavioral assessment in rats

瞄准：证实内脏的疼痛经由颜色为表面的扩张(CRD ) 建模并且由在老鼠测量腹的屈肌反射(AWR ) 的分数评估 CRD 的行为的回答的效率。方法：称 180-240 g 的 38 只男 SD 老鼠被用来建立内脏的疼痛模型。老鼠与 7 厘米 intra-anally 被插入在醚麻醉下面的长灵活的乳胶汽球，和由与空气使汽球膨胀的表面的扩张在从麻醉恢复以后被成为 30 min 的颜色。五个 AWR 分数(到 AWR4 的 AWR0 ) 被用来估计有害内脏的刺激的紧张。它被认为是最低压(kPa ) 的阀值。因为腹的 flatting 被颜色导致表面的扩张。结果：到下降冒号和直肠的扩张的精力旺盛的 AWR 在 100% 被发现醒着测试的老鼠。越高扩张的压力，越 higher AWR 的分数。0， 2.00， 3.33， 5.33 和 8.00 kPa 的扩张压力生产了不同 AWR 分数(P【0.05 ) 。AWR 的痛觉阈为在起始的终结(第一 1-3 扩张) 以后的多达 80 min 是不变的，吝啬的阀值是 3.69+/-0.35 kPa。吗啡硫酸盐的全身的管理在一个剂量依赖者和 naloxone 提高了内脏的疼痛的阀值可逆举止。结论：在表面的扩张能估计的颜色期间获得 AWR 有害内脏的刺激的紧张。到内脏的痛觉阈清楚、不变、可靠的 CRD 的腹部(AWR 3 ) 的 Flatting。这个疼痛模型和它的行为的评价对关于内脏的疼痛和止痛剂的研究好。

Abnormal endogenous pain modulation and somatic and visceral hypersensitivity in female patients with irritable bowel syndrome

AIM: To investigate the role of endogenous pain modulatory mechanisms in the central sensitization implicated by the visceral hypersensitivity demonstrated in patients with irritable bowel syndrome (IBS). Dysfunction of modulatory mechanisms would be expected to also result in changes of somatic sensory function. METHODS: Endogenous pain modulatory mechanisms were assessed using heterotopic stimulation and somatic and visceral sensory testing in IBS. Pain intensities (visua analogue scale, VAS 0-100) during suprathreshold recta distension with a barostat, cold pressor stimulation of the foot and during both stimuli simultaneously (heterotopic stimulation) were recorded in 40 female patients with IBS and 20 female healthy controls. RESULTS: Rectal hypersensitivity (defined by 95% CI of controls) was seen in 21 (53%), somatic hypersensitivity in 22 (55%) and both rectal and somatic hypersensitivity in 14 of these IBS patients. Heterotopic stimulation decreased rectal pain intensity by 6 (-11 to -1) in controls, but increased rectal pain by 2 (-3 to +6) in all IBS patients (P < 0.05) and by 8 (-2 to +19) in IBS patients with somatic and visceral hypersensitivity (P < 0.02). CONCLUSION: A majority of IBS patients had abnormal endogenous pain modulation and somatic hypersensitivity as evidence of central sensitization.

Translational pain research: Evaluating analgesic effect in experimental visceral pain models

Deep visceral pain is frequent and presents major challenges in pain management, since its pathophysiology is still poorly understood. One way to optimize treatment of visceral pain is to improve knowledge of the mechanisms behind the pain and the mode of action of analgesic substances. This can be achieved through stand-ardized experimental human pain models. Experimental pain models in healthy volunteers are advantageous for evaluation of analgesic action, as this is often diff icult to assess in the clinic because of confounding factors such as sedation, nausea and general malaise. These pain models facilitate minimizing the gap between knowledge gained in animal and human clinical studies. Combining experimental pain studies and pharmacokinetic stud- ies can improve understanding of the pharmacokinetic-pharmacodynamic relationship of analgesics and, thus, provide valuable insight into optimal clinical treatment of visceral pain. To improve treatment of visceral pain, it is important to study the underlying mechanisms of pain and the action of analgesics used for its treatment. An experimental pain model activates different modalities and can be used to investigate the mechanism of action of different analgesics in detail. In combination with pharmacokinetic studies and objective assessment such as electroencephalography, new information re-garding a given drug substance and its effects can be obtained. Results from experimental human visceral pain research can bridge the gap in knowledge between animal studies and clinical condition in patients suffering from visceral pain, and thus constitute the missing link in translational pain research.

Moxibustion eases chronic inflammatory visceral pain through regulating MEK, ERK and CREB in rats

AIM To investigate the effects of herb-partitioned moxibustion(HPM) on phosphorylation of mitogen-activated extracellular signal-regulated kinase(MEK)1, extracellular signal-regulated kinase(ERK)1/2 and c AMP response element binding protein(CREB) in spinal cord of rats with chronic inflammatory visceral pain(CIVP), and to explore the central mechanism of HPM in treating CIVP.METHODS Male Sprague-Dawley rats were randomized into normal, model, HPM, sham-HPM, MEK-inhibitor and dimethyl sulfoxide(DMSO) groups. The CIVP model was established using an enema mixture of trinitrobenzene sulfonic acid and ethanol. HPM was applied at bilateral Tianshu(ST25) and Qihai(CV6) acupoints in the HPM group, while in the sham-HPM group, moxa cones and herb cakes were only placed on the same points but not ignited. The MEK-inhibitor and DMSO groups received L5-L6 intrathecal injection of U0126 and 30% DMSO, respectively. Abdominal withdrawal reflex(AWR), mechanical withdrawal threshold(MWT) and thermal withdrawal latency(TWL) were applied for the assessment of pain behavior. The colonic tissue was observed under an optical microscope after hematoxylin-eosin staining. Expression of phosphor(p)MEK1, p ERK1/2 and p CREB in rat spinal cord was detected using Western blotting. The levels of MEK, ERK and CREB m RNA in rat spinal cord were detected using real-time polymerase chain reaction. RESULTS Compared with the normal group, the AWR scores were increased significantly(P < 0.01) and the MWT and TWL scores were decreased significantly(P < 0.05) in the model, sham-HPM and DMSO groups. Compared with the model group, the AWR scores were decreased significantly(P < 0.01) and the MWT and TWL scores were increased significantly in the HPM and MEK-inhibitor groups(P < 0.05). Compared with the sham-HPM and DMSO groups, the AWR scores were decreased significantly(P < 0.01) and the MWT and TWL scores were increased significantly(P < 0.05) in the HPM and MEK-inhibitor groups. Compared with the normal group, the expression of p MEK1, p ERK1/2 and p CREB proteins and the levels of MEK, ERK and CREB m RNA in rat spinal cord were increased significantly in the model, sham-HPM and DMSO groups(P < 0.01 or < 0.05). Compared with the model group, the expression of p MEK1, p ERK1/2 and p CREB proteins and the levels of MEK, ERK and CREB m RNA in rat spinal cord were reduced significantly in the HPM and MEK-inhibitor groups(P < 0.01 or < 0.05). Compared with the sham-HPM and DMSO groups, expression of p MEK1, p ERK1/2 and p CREB proteins and the levels of MEK, ERK and CREB m RNA in rat spinal cord were reduced significantly in the HPM and MEK-inhibitor groups(P < 0.01 or < 0.05). CONCLUSION HPM down-regulates protein phosphorylation of MEK1, ERK1/2 and CREB, and m RNA expression of MEK, ERK and CREB, inhibiting activation of the MEK/ERK/CREB signaling pathway in the spinal cord of CIVP rats, which is possibly a critical central mechanism of the analgesic effect of HPM.

Targeting voltage-gated sodium channels for treatment for chronic visceral pain

Voltage-gated sodium channels (VGSCs) play a fundamental role in controlling cellular excitability,and their abnormal activity is related to several pathological processes,including cardiac arrhythmias,epilepsy,neurodegenerative diseases,spasticity and chronic pain.In particular,chronic visceral pain,the central symptom of functional gastrointestinal disorders such as irritable bowel syndrome,is a serious clinical problem that affects a high percentage of the world population.In spite of intense research efforts and after the dedicated decade of pain control and research,there are not many options to treat chronic pain conditions.However,there is a wealth of evidence emerging to give hope that a more refined approach may be achievable.By using electronic databases,available data on structural and functional properties of VGSCs in chronic pain,particularly functional gastrointestinal hypersensitivity,were reviewed.We summarize the involvement and molecular bases of action of VGSCs in the pathophysiology of several organic and functionalgastrointestinal disorders.We also describe the efficacy of VGSC blockers in the treatment of these neurological diseases,and outline future developments that may extend the therapeutic use of compounds that target VGSCs.Overall,clinical and experimental data indicate that isoform-specific blockers of these channels or targeting of their modulators may provide effective and novel approaches for visceral pain therapy.

Acupuncture and moxibustion for visceral pain

Totally three articles focusing on"analgesic action of suspended moxibustion effect in visceral hypersensitivity rats with irritable bowel syndrome,and changes in prokineticin 1 and prokineticin receptor 1 expression in the spinal cord,enkephalins in the spinal cord and prokineticin-1 and prokineticin receptor-1 in the colon tissue during the analgesic progress"were

Electroacupuncture Attenuates Visceral Pain and Reverses Upregulation of TRPV1 Expression in Adult Rats with Neonatal Maternal Deprivation

Irritable bowel syndrome (IBS) is characterized by chronic visceral hypersensitivity that companied by altered bowel movement. However, the treatment options are very limited. The aim of this study was to investigate effects of electroacupuncture (EA) on visceral hypersensitivity in a rat model of IBS and to explore the underlying mechanisms of EA effects. Visceral hypersensitivity was established by neonatal maternal deprivation (NMD) in male rats on postnatal days 2 - 15. Behavioral experiments were conducted at the age of 7 weeks. Treatment with EA at Zusanli (stomach-36, ST-36) significantly reduced abdominal withdrawal reflex (AWR) scores in NMD rats but not in age-matched healthy control rats. In addition, EA treatment hyperpolarized resting membrane potentials, increased the rheobase and reduced the numbers of action potentials evoked by 2 and 3 times rheobase current stimulation of dorsal root ganglion (DRG) neurons innervating the colon. NMD markedly enhanced expression of TRPV1 in colon related DRGs while EA treatment drastically suppressed the expression of TRPV1 in DRGs of NMD rats. These data suggest that EA treatment produced an analgesic effect, which might be mediated at least in a part by suppression of TRPV1 expression and by inhibition of neuronal excitability of primary sensory neurons in rats with chronic visceral pain.

冲击波联合肌筋膜触发点治疗神经根型颈椎病疗效观察

目的:探讨发散式体外冲击波联合针刺肌筋膜触发点治疗神经根型颈椎病(CSR)的疗效。方法:将80例神经根型颈椎病患者随机分为两组,各40例。两组患者均给予颈椎牵引、口服甲钴胺片,对照组在此基础上给予发散式体外冲击波联合普通针刺治疗,观察组给予发散式体外冲击波联合针刺颈肩部肌筋膜触发点治疗。比较两组治疗前后简化McGill疼痛问卷(SF-MPQ)、颈椎功能障碍指数量表(NDI)及中文版简明健康调查问卷(SF-36)评分变化情况,比较两组治疗后的临床疗效及6个月内的复发情况。结果:两组均治疗4周,治疗前,两组患者一般资料、SF-MPQ、NDI、SF-36评分组间比较,无统计学差异(P>0.05)。治疗后,两组患者的SF-MPQ评分、NDI评分较治疗前均降低(P<0.05),SF-36评分较治疗前均升高(P<0.05);组间比较,观察组患者的SF-MPQ、NDI及SF-36改善程度均优于对照组(P<0.05);治疗后,观察组总有效率(97.5%)高于对照组(80.0%),治疗后6个月内观察组复发率(5%)低于对照组(25%),差异均有统计学意义(χ^(2)=4.507、6.275,均P<0.05)。结论:发散式体外冲击波联合肌筋膜触发点治疗能够有效减轻神经根型颈椎病患者的疼痛症状,改善颈椎功能,提高生活质量,临床疗效显著,复发率低。

慢性内脏痛及诱发负性情绪的神经回路研究进展

慢性内脏痛及其诱发的负性情绪严重影响了病人的生活质量,并产生巨大的社会经济负担。然而,与其相关的神经回路和机制仍是尚未解决的生命科学难题。前扣带回和杏仁核是处理啮齿类动物和人类慢性疼痛感觉和情绪成分的核心脑区,因此,本文以慢性内脏痛中功能性胃肠疾病(肠易激综合征)为例,重点围绕上述核团,从神经回路水平,总结并分析肠易激综合征啮齿类动物模型内脏痛及诱发负性情绪脑回路的最新发现。同时还讨论了今后该研究领域相关的重要研究方向,为揭示慢性内脏痛及诱发负性情绪的机制研究提供新线索。

TRP通道与炎症性肠病内脏高敏感相关研究进展

炎症性肠病(inflammatory bowel disease,IBD)是临床常见的慢性、复发性炎症性疾病,其主要特点是肠道弥漫性炎症和内脏敏感性改变,且病因及发病机制复杂。瞬时受体电位(transient receptor potential,TRP)通道于胃肠道分布广泛,作为多种刺激的检测器、效应器和信号转导器参与调控IBD肠道炎症和内脏高敏感(visceral hypersensitivity,VHS),并对其产生促进或抑制作用。本文就已知主要的TRP通道与IBD中VHS的相关研究进展作一综述。

肥大细胞在内脏高敏疼痛发生机制中作用的研究进展

内脏高敏状态是肠应激综合征(irritable bowel syndrome,IBS)、功能性肛门直肠痛、慢性盆腔疼痛等疾病的常见表现,而疼痛是此类疾病常见的症状之一。目前,内脏高敏疼痛的发生机制尚不明确,也尚无明确有效的治疗方法。目前研究发现,肥大细胞在内脏高敏性疼痛的发生和维持中发挥重要作用。肥大细胞可能通过提高内脏敏感性,以及影响神经内分泌免疫网络从而导致内脏高敏疼痛的发生。因此调节肥大细胞的功能可能成为治疗内脏高敏性疼痛的新途径之一。本文总结了肥大细胞在内脏高敏疼痛发生机制中可能的作用,并基于上述机制对内脏高敏疼痛的治疗作一展望。

基于“肠脑互动”探讨大建中汤治疗肠易激综合征大鼠内脏痛作用机制

目的研究大建中汤对肠易激综合征(irritable bowel syndrome,IBS)大鼠内脏痛的影响及神经-免疫-内分泌网络的分子机制。方法将新生大鼠48只,随机分为正常对照组(control组)、肠易激综合征模型组(IBS组)、酮替芬组(Ketotifen组)、低剂量大建中汤治疗组(DJZT-L)、中剂量大建中汤治疗组(DJZT-M)、高剂量大建中汤治疗组(DJZT-H)。采用母婴分离法制备IBS内脏痛大鼠模型,利用腹壁撤退反应(abdominal withdrawal reflex,AWR)评估大鼠内脏敏感性;免疫组化法测定大鼠下丘脑星形胶质细胞(glial fibrillary acidic protein,GFAP)、小胶质细胞(OX-42);免疫蛋白印迹(Western blot,WB)检测结肠和下丘脑P物质(substance P,SP);甲苯胺蓝染色法检测结肠组织肥大细胞(mast cell,MC)脱颗粒率;酶联免疫吸附法(enzyme-linked immunosorbentassay,ELISA)测定分析结肠组织SP、特异性IgE(sIgE)和组胺。结果与正常大鼠相比,模型大鼠中60、40和20 mm Hg压力下AWR评分明显升高(P<0.05),下丘脑GFAP、OX-42、SP表达显著上升(P<0.05),结肠组织中肥大细胞脱颗粒率、sIgE、组胺和SP表达显著上升(P<0.05);与模型大鼠相比,大建中汤高剂量组(40和20 mm Hg压力),大建中汤中剂量组(60、40和20 mm Hg压力)的AWR评分,下丘脑GFAP、OX-42、SP,结肠肥大细胞脱颗粒率、sIgE、组胺、SP表达明显下降(P<0.05)。结论大建中汤能够降低IBS模型大鼠内脏痛,可能与其抑制SD大鼠结肠组织中肥大细胞活性,进而影响免疫神经网络有关。

颈椎旋提手法对颈型颈椎病患者疼痛、颈椎矢状位参数的改善作用观察

【目的】观察颈椎旋提手法治疗颈型颈椎病(neck type cerivical spondylopathy,NTCS)后颈椎正侧双斜位数字化X线摄影(digital radiography,DR)上的矢状位参数的变化,结合疼痛程度视觉模拟量表(visual analogue scale,VAS)评分探究颈椎矢状位参数在评估NTCS疗效方面的临床意义。【方法】采用回顾性研究方法,选取2020年11月至2021年5月佛山市中医院推拿科门诊收治的36例NTCS患者为研究对象,根据治疗方法的不同,将36例患者分为试验组和对照组,每组各18例。试验组采用旋提手法治疗,对照组采用颈椎牵引治疗,均隔日治疗1次,持续治疗2周。观察2组患者治疗前后疼痛程度VAS评分及颈椎正侧双斜位DR上的矢状位参数[颈椎2-7矢状位偏移(C2-7 SVA)、胸1倾斜角(T1S)、颈倾斜角(NT)、胸廓入口角(TIA)]的变化情况,并采用Spearman相关性检验分析疼痛程度VAS评分与颈椎矢状位参数值之间的相关性。【结果】(1)治疗前,2组患者的疼痛程度VAS评分比较,差异无统计学意义(P>0.05)。治疗后,2组患者的疼痛程度VAS评分均较治疗前明显降低(P<0.05),且试验组的降低作用明显优于对照组(P<0.01)。(2)治疗前,2组患者的C2-7 SVA、T1S、NT、TIA等颈椎矢状位参数值比较,差异均无统计学意义(P>0.05)。治疗后,试验组的C2-7 SVA、T1S、TIA均较治疗前明显改善(P<0.05),NT改善不明显(P>0.05);对照组的各项颈椎矢状位参数值均较治疗前无明显改善(P>0.05);组间比较,试验组对C2-7 SVA、T1S、TIA等颈椎矢状位参数值的改善作用均明显优于对照组(P<0.05或P<0.01),而2组患者治疗后的NT值比较,差异无统计学意义(P>0.05)。(3)Spearman相关性检验结果显示:治疗前,疼痛程度VAS评分与C2-7 SVA、T1S、NT、TIA无相关性(P>0.05);C2-7 SVA与NT呈负相关(r=-0.502,P<0.05);T1S与NT呈正相关(r=0.601,P<0.05)。治疗后,疼痛程度VAS评分与C2-7 SVA呈负相关(r=-0.362,P<0.05),与TIA呈正相关(r=0.476,P<0.05);C2-7 SVA与NT呈正相关(r=0.928,P<0.05);T1S与TIA呈正相关(r=0.623,P<0.05)。【结论】(1)颈椎旋提手法、颈椎牵引均可以缓解NTCS患者的疼痛程度和调整颈椎矢状位参数,但相比较而言,颈椎旋提手法治疗NTCS的疗效更加显著;(2)NTCS患者疼痛程度VAS评分与颈椎矢状位参数可能存在一定相关性。

针灸推拿联合颈椎牵引治疗对神经根型颈椎病患者肩部疼痛及颈椎功能的影响

目的探讨神经根型颈椎病(Cervical Spondylotic Radiculopathy,CSR)患者行针灸、推拿与颈椎牵引共治对肩部疼痛及颈椎功能的影响。方法随机选取2020年5月—2023年5月厦门市第五医院确诊的60例CSR患者作为研究对象,并依照随机数表法分为对照组和观察组,各30例。对照组仅接受颈椎牵引治疗,观察组基于对照组治疗条件下增加针灸推拿治疗,比较两组的中医证候、肩部疼痛状况、颈椎功能以及复发率。结果治疗后,观察组各项中医证候积分以及总积分均低于对照组,差异有统计学意义(P均<0.05)。治疗后,观察组肩部疼痛症状[视觉模拟评分法(Visual Analogue Scale,VAS)]得分低于对照组,差异有统计学意义(P<0.05)。治疗后,观察组颈椎功能障碍指数量表(Cervical Spine Dysfunction Index Scale,NDI)得分低于对照组,颈椎生理曲度高于对照组,差异有统计学意义(P均<0.05)。观察组治疗后3个月的复发率(0)低于对照组(20.00%),差异有统计学意义(χ^(2)=4.629,P=0.031)。结论针灸推拿联合颈椎牵引疗法可更有效缓解CSR患者的中医证候,减轻肩部疼痛症状,促进患者颈椎功能恢复,并降低复发率。