Traditional Chinese medicine for foot pain in a patient with complex regional pain syndrome: A case report

BACKGROUND Complex regional pain syndrome(CRPS)is characterized by pain as well as sensory,motor,and sudomotor disorders.Generally,it is classified into two types CRPS-I and CRPS-II.There is no single diagnostic test or treatment approach for CRPS,and a multidisciplinary approach is gaining attention to improve patients’symptoms and their quality of life.CASE SUMMARY A 35-year-old woman with an unremarkable medical history sought treatment for CRPS at a hospital of Korean medicine.During her first visit,she was wheelchairbound due to severe pain in her left lower extremity.She had edema and discoloration of the left foot.She was treated with a combination of traditional Chinese medicine(TCM)approaches,including acupuncture,moxibustion,pharmacopuncture,and herbal decoction,for approximately 20 sessions.The foot and ankle outcome score(FAOS)and visual analog scale(VAS)score for pain were evaluated,along with general signs and functions.Her symptoms,signs,FAOS,and VAS scores improved after treatment,with a significant 7-degree decrease in the VAS score and a 62-point increase in the FAOS score.Additionally,the foot swelling and discoloration gradually resolved.During the phone follow-up,5 mo after the last visit,additional improvements in outcomes were observed.CONCLUSION Combined TCM treatment may be a reasonable and safe option for alleviating symptoms and improving function in patients with CRPS.

International study of the Complex Stress Reaction Syndrome:Implications for transdiagnostic clinical practice

BACKGROUND The debate regarding diagnostic classification systems in psychiatry(categorial vs dimensional systems)has essential implications for the diagnosis,prevention and treatment of stress reactions.We previously found a unique pattern of stress reaction in a study executed during the coronavirus disease 2019 pandemic using large representative samples in two countries,and termed it the Complex Stress Reaction Syndrome(CSRS).AIM To investigate CSRS,Type A(psychiatric symptoms,spanning anxiety,depression,stress symptoms,and posttraumatic stress disorder(PTSD)),with or without long-coronavirus disease(COVID)residuals(CSRS,Type B,neuropsychiatric symptoms spanning cognitive deficits and fatigue,excluding systemic symptoms).Our two-tailed hypothesis was that CSRS is a condition related to an unrecognized type of stress reaction in daily life in the general population(Type A)or that it is related to the severe acute respiratory syndrome coronavirus 2 infection and its long-COVID residuals(Type B).METHODS 977 individuals in four continents(North America,Europe,Australia and the Middle East)completed the online study questionnaire in six languages using the Qualtrics platform.The study was managed by six teams in six countries that promoted the study on social media.The questionnaire assessed anxiety,depression,stress symptoms and PTSD(CSRS,Type A),cognitive deficits and fatigue(CSRS,Type B).The data were analyzed using Proportion Analyses,Multivariate Analysis of Co-Variance(MANCOVA),linear regression analyses and validated clinical cutoff points.RESULTS The results of the Proportion Analyses showed that the prevalence of 4 symptoms spanning anxiety,depression,stress symptoms,and PTSD was significantly higher than the most prevalent combinations of fewer symptoms across 4 continents,age groups,and gender.This supports the transdiagnostic argument embedded in the CSRS(Type A).The same pattern of results was found in infected/recovered individuals.The prevalence of the 4 psychiatric symptoms combination was significantly greater than that of 5 and 6 symptoms,when adding cognitive deficits and fatigue,respectively.MANCOVA showed a significant three-way interaction(age×gender×continent).Further analyses showed that the sources of this three-way interaction were threefold relating to two sub-populations at-risk:(1)Individuals that self-identified as non-binary gender scored significantly higher on all 4 psychiatric symptoms of the CSRS,Type A at young age groups(<50 years old)in North America compared to(self-identified)women and men located in the 4 continents studied,and to other ages across the adult life span;and(2)This pattern of results(CSRS,Type A)was found also in women at young ages(<40 years old)in North America who scored higher compared to men and women in other continents and other ages.Linear regression analyses confirmed the MANCOVA results.CONCLUSION These results show a combined mental health risk factor related to stress reactivity,suggesting that the CSRS is sensitive to populations at risk and may be applied to future identification of other vulnerable sub-populations.It also supports the transdiagnostic approach for more accurate prevention and treatment.Time will tell if such transdiagnostic syndromes will be part of the discussions on the next revisions of the traditional classification systems or whether the crisis in psychiatry further evolves.

Impact of adolescent complex regional pain syndrome on the psychopathology of young men ahead of military service: A retrospective cohort analysis of Korean conscription data

Background: The relationship between physical and psychopathological features in complex regional pain syndrome(CRPS) has been a subject of constant interest, but no data are available in adolescents. Therefore, we aimed to identify the factors associated with psychopathology in adolescents with CRPS ahead of military service.Methods: We retrospectively reviewed all conscription examinees who had completed a Military Personality Inventory(MPI) during a period between February 2013 and December 2016. A total of 63 persons with a history of CRPS(19-years of age for all) were enrolled. Basic demographic and pain-related data were analyzed to examine their association with MPI results. The mean FGR score as well as the 8 subdomain scores were compared between those with pain duration at <15 months(n=30) vs. ≥15 months(n=33). Binary MPI results(normal-abnormal) were also compared between the two groups.Results: In multivariate analysis, abnormal MPI was associated with pain duration, with an odds ratio(OR) at 1.05 for every 1-month increase [95% confidence interval(CI) 1.02–1.08;P=0.002]. Subjects with pain duration at ≥15 months have lower faking good response score(P<0.001 vs. those with pain duration at <15 months), and higher abnormal MPI result rate, faking bad response, inconsistency, anxiety, depression, somatization, paranoid, personality disorder cluster A, and personality disorder cluster B scores(P<0.05). Pain duration was significantly associated with the MPI variables.Conclusions: Pain duration is associated with psychopathology in adolescents with CRPS. Psychopathologic features increased as the disease duration increased. A comprehensive understanding of time-dependent psychopathological factors could support the planning of multimodal approaches for managing adolescent CRPS.

Characterization of the microbial community response to replant diseases in peach orchards

This study attempted to monitor the development of microbial communities and reveal the correlation between the soil microbial community and soil nutrient factors over different years following the replanting of peach trees.The replanted soil(RS)and nonreplanted soil(NRS)were collected from peach orchards with different growth years(1,3,5,7,9,11,and 13 years)in the same region.The soil bacterial and fungal community diversities were analyzed by high-throughput sequencing technology.Redundancy analysis(RDA)was used to show the correlation between the soil microbial community and environmental variables.The alpha diversities of the bacterial and fungal communities indicated that RS contained a higher abundance of bacterial and fungal operational taxonomic units(OTUs)than NRS.NMDS and ANOSIM analyses showed that the soil bacterial and fungal communities were significantly(P<0.01)affected by planting years,and that the main changes occurred in the first and ninth planting years.The presence of the bacterial orders Sphingobacteriales,Burkholderiales and Actinomycetales changed significantly after replanting.Some bacteria associated with bioremediation,such as Burkholderiales and Intrasporangiaceae,and some harmful pathogens,such as Penicillium and Ophiostomatales,significantly increased after replanting(LDA score>3.0).In addition,the soil nutrient contents were lower in RS than in NRS in the early stage(1–5 years),and the RDA showed that bacterial and fungal phyla are closely associated with environmental variables,including the potential of hydrogen(pH),ammonium nitrogen(AN),available phosphorus(AP)and available potassium(AK).These results lead to a deeper understanding of the microbial responses to replanting in peach orchards.

High-intensity swimming alleviates nociception and neuroinflammation in a mouse model of chronic postischemia pain by activating the resolvin E1-chemerin receptor 23 axis in the spinal cord

Physical exe rcise effectively alleviates chronic pain associated with complex regional pain syndrome type-Ⅰ.However,the mechanism of exe rcise-induced analgesia has not been clarified.Recent studies have shown that the specialized pro-resolving lipid mediator resolvin E1 promotes relief of pathologic pain by binding to chemerin receptor 23 in the nervous system.However,whether the resolvin E1-chemerin receptor 23 axis is involved in exercise-induced analgesia in complex regional pain syndrome type-Ⅰ has not been demonstrated.In the present study,a mouse model of chronic post-ischemia pain was established to mimic complex regional pain syndrome type-Ⅰ and subjected to an intervention involving swimming at different intensities.Chronic pain was reduced only in mice that engaged in high-intensity swimming.The resolvin E1-chemerin receptor 23 axis was clearly downregulated in the spinal cord of mice with chronic pain,while high-intensity swimming restored expression of resolvin E1 and chemerin receptor 23.Finally,shRNA-mediated silencing of chemerin receptor 23in the spinal cord reve rsed the analgesic effect of high-intensity swimming exercise on chronic post-ischemic pain and the anti-inflammato ry pola rization of microglia in the dorsal horn of the spinal cord.These findings suggest that high-intensity swimming can decrease chronic pain via the endogenous resolvin E1-chemerin receptor 23 axis in the spinal cord.

Pain management of hemiplegic shoulder pain post stroke in patients from Nanjing,China

We selected 106 hemiplegic patients with shoulder pain hospitalized after stroke from three hospi- tals in Nanjing, China between February 2007 and January 2012. All patients had complete clinical data sets and accounted for 45.5% of the inpatients because of stroke. Results showed that the number of patients with hemiplegic shoulder pain post stroke increased yearly, attacking mainly males 50-69 years of age. Of 106 patients, there were 60 cases （56.6%） of adhesive capsulitis, 19 （17.9%） of shoulder subluxation, 14 （13.2%） of complex regional pain syndrome, and 13 （12.6%） of central pain. The main symptoms were shoulder pain （100%）, limit of shoulder mobility （98.1%）, and adhesion of the scapula （56.6%）. MRI of the shoulder showed tendon and ligament lesions （57.1%） and rotator cuff tear （38.1%）. 53.8% of central pain was related to the thalamus, in addition to the basal ganglia, brain stem, and cerebellopontine angle. Shoulder pain, upper limb motor function, and function independence were significantly improved after comprehensive rehabilitation. In par- ticular, electroacupuncture based on basic physical therapy exhibited efficacy on shoulder subluxa- tion and complex regional pain syndrome. Multiple linear regression results showed a negative re- lationship of efficacy of pain management with the attack period of shoulder pain, involvement of the posterior limb of the internal capsule, and duration between onset and rehabilitation treatment, but a positive correlation with pain-related education, pain regression period, and pain diagnosis.

Neuronal changes resulting in up-regulation of alpha-1 adrenoceptors after peripheral nerve injury

Under normal conditions, the sympathetic neurotransmitter noradrenaline inhibits the production and release of pro-inflammatory cytokines. However, after peripheral nerve and tissue injury, pro-inflammatory cytokines appear to induce the expression of the alphalA-adreno- ceptor subtype on immune cells and perhaps also on other cells in the injured tissue. In turn, noradrenaline may act on up-regulated alphal-adrenoceptors to increase the production of the pro-inflammatory cytokine interleukin-6. In addition, the release of inflammatory mediators and nerve growth factor from keratinocytes and other cells may augment the expression of alphal-adrenoceptors on peripheral nerve fibers. Consequently, nociceptive afferents acquire an abnormal excitability to adrenergic agents, and inflammatory processes build. These mechanisms could contribute to the development of sympathetically maintained pain in conditions such as post-herpetic neuralgia, cutaneous neuromas, amputation stump pain and complex regional pain syndrome.

A single-center retrospective study on epidemiological and Traditional Chinese Medicine syndrome characteristics of 21010 patients with reflux/heartburn symptoms

OBJECTIVE:To provide a basis for the clinical identification of true and false reflux,integrated traditional Chinese and Western medicine,and psychosomatic treatment,we conducted a retrospective study of the etiology and epidemiological and Traditional Chinese Medicine(TCM) syndrome characteristics of patients with reflux/heartburn symptoms.METHODS:The 210 10 patients with reflux/heartburn treated at Tianjin Nankai Hospital from January 1,2016,to December 31,2019,were divided into four groups according to their pathogenesis.Sex,age,course of disease,incidence rate,gastroscopy,24-h p Himpedance,esophageal manometry,Hamilton Anxiety Scale(HAMA)/Hamilton Depression Scale(HAMD) score,8-week proton pump inhibitor(PPI) treatment effect,and TCM syndrome characteristics were statistically analyzed.RESULTS:A total of 21010 patients(8864 men and 12146 women),with reflux/heartburn symptoms were screened,including 6284(29.9%) patients with reflux esophagitis(RE),10427(49.6%) patients with nonerosive reflux esophagitis(NERD),2430(11.6%) patients with reflux hypersensitivity(RH),and 1870(8.9%) patients with functional heartburn(FH).The incidence of the disease was higher in women than in men(P <0.0001).The ranking of the incidence of anxiety and depression in these four groups was FH > RH > NERD > RE(P < 0.0001).There were more women than men in the groups with anxiety and more men than women in the groups with depression(P < 0.0001),and there was no significant difference in the distribution of anxiety and depression between men and women(P = 0.5689).There were significant differences in TCM syndrome characteristics between NERD,RE,and functional esophageal diseases(P < 0.01).The highest proportion of functional esophageal disease TCM symptoms was Qi stagnation and phlegm obstruction syndrome(36.16%),and there was no significant difference between RH and FH.The effective rates of PPI treatment at 8 weeks in patients in the RE,NERD,RH,and FH groups were 89%,72%,54%,and 0%,respectively.RE was classified into grades A,B,C,and D according to the Los Angeles grading system.The ranking of the incidence of these four grades was A > B > C > D(P < 0.0001).The effective rates of PPI treatment at 8 weeks were 91%,81%,69%,and 63% in patients with grade A,B,C,and D RE,respectively(P < 0.0001).The highest proportion of TCM syndrome types of NERD and RE was the stagnated heat syndrome in the liver and stomach syndrome,38.99% and 33.90%,respectively.CONCLUSION:Reflux/heartburn symptoms are relatively common in middle-aged women,and NERD is the most common etiology,followed by RE,RH,and FH.The most common TCM syndrome characteristics in NERD and RE were stagnated heat syndrome in the liver and stomach syndrome,and Qi stagnation and phlegm obstruction syndrome in functional esophageal diseases.Most patients with reflux/heartburn symptoms also experienced anxiety and depression.

Traditional Chinese Medicine syndrome analysis on oxaliplatin-induced peripheral neuropathy and clinical efficacy of Bushen Yiqi formula(补肾益气方):a prospective randomized controlled study

OBJECTIVES:To analyze the distribution characteristics of Traditional Chinese Medicine(TCM)syndromes in patients with oxaliplatin-induced peripheral neuropathy(OIPN)and observe the clinical efficacy of Bushen Yiqi formula(补肾益气方,BSYQF)in treating patients with OIPN.METHODS:A total of 89 patients with OIPN were enrolled in this study.The TCM syndrome characteristics were investigated by frequency analysis methodology after collecting and analyzing the TCM syndrome elements of the patients with the OIPN TCM syndrome element scale.Further,62 cases of cold-dampness obstruction syndrome and kidney-Qi deficiency and cold syndrome were selected and randomly divided into the control group(n=31)and the treatment group(n=31).The patients in the treatment group were treated with modified BSYQF,while those in the control group were treated with mecobalamin tablets for 3 weeks.The Levi sensory neurotoxicity score and the neuro-electrophysiological changes were observed before and after the treatment in both groups.RESULTS:The distribution of TCM syndrome types in 89 patients with OIPN were in order of kidney-Qi deficiency and cold syndrome(44 cases),cold-dampness obstruction syndrome(18 cases),Yin deficiency of liver and kidney syndrome(11 cases),blood stasis obstruction syndrome(7 cases),and dampness-heat obstruction syndrome(5 cases).Improvement in Levi sensory neurotoxicity score:After 3-week treatment,the total effective rate in the treatment group was higher than that in the control group(P<0.05).The subgroup analysis showed that the total effective rate in the treatment group of patients with kidney-Qi deficiency and cold syndrome was higher than that in the control group before and after treatment(P<0.05).Improvement in nerve conduction velocity:The sensory nerve conduction velocity of bilateral ulnar nerves improved in the control group after treatment compared with that before treatment(P<0.05).The sensory and motor nerve conduction velocities of the bilateral ulnar and bilateral peroneal nerves improved in the treatment group compared with those before treatment and after treatment in the control group(P<0.05).CONCLUSIONS:The modified BSYQF had a definite therapeutic effect on the OIPN in patients with kidney-Qi deficiency and cold syndrome and those with cold-dampness obstruction syndrome.It could effectively reduce the grade of peripheral nerve toxicity and improve nerve conduction velocity,and its curative effect was better than that of mecobalamin tablets.

Value of Traditional Chinese Medicine syndrome differentiation in predicting the survival time of patients with advanced cancer

OBJECTIVE:To prospectively study the accuracy of the palliative prognostic index(PPI)survival prediction model combined with Traditional Chinese Medicine(TCM)syndrome differentiation.METHODS:The PPI survival prediction model was used to predict survival time.Patients'real survival time was recorded.The survival time was calculated using the Kaplan-Meier method,and the logrank method was used to test the difference.RESULTS:The average PPI survival prediction score of 227 patients was 5.83(95%CI:5.29-6.37).There was a significant difference in the real-life period between the different PPI groups(P<0.05).PPI group Ⅰ(predicted survival of >6 weeks)showed the highest predictive sensitivity and PPI group Ⅱ(predicted survival of 3-6 weeks)showed the highest predictive specificity.According to TCM syndrome differentiation,82 cases(36%)were diagnosed with liver and kidney Yin deficiency(type Ⅳ).The actual survival time of type Ⅳ patients was significantly shorter than that of other types of patients(mean:21.85 vs 28.70,P=0.007).In group Ⅰ,the median survival time of type Ⅳ patients and other types was 25 and 34 d,respectively(P<0.001).The sensitivity and specificity of PPI prediction were improved in group Ⅱ by TCM syndrome differentiation.For patients in group Ⅲ whose predicted survival time was<3 weeks,the specificity of PPI survival prediction was higher in type Ⅳ patients.CONCLUSION:This study shows that the PPI predictive tool for survival rate has important value.TCM syndrome differentiation and typing has certain significance for further classification and survival prediction.

Noninvasive identificational diagnosis of diabetic nephropathy and non-diabetic renal disease based on clinical characteristics of Traditional Chinese Medicine symptom pattern and conventional medicine

OBJECTIVE:To study the clinical characteristics relating to differential diagnosis of diabetic nephropathy(DN) and non-diabetic renal disease(NDRD).METHODS:The subjects were patients with type 2 diabetes mellitus(T2DM) complicated with chronic kidney disease(CKD).Western medical history data and Traditional Chinese Medicine(TCM) symptom pattern were collected,and logistic regression was used to analyze.RESULTS:Blood deficiency pattern [odds ratio(OR) = 2.269,P = 0.017] and Qi stagnation pattern(OR = 1.999,P = 0.041) are independently related to DN.CONCLUSIONS:TCM factors blood deficiency pattern and Qi stagnation pattern are relating to differential diagnosis of DN and NDRD.

Liver metabolomic characteristics in three different rat models of Yin deficiency based on ultra-performance liquid chromatography coupled to quadrupole time-of-flight mass spectrometry

OBJECTIVE:To investigate the mechanism of Yin deficiency syndrome(YDS) by analyzing the liver metabolomic characteristics of three different Yin deficiency rat models METHODS:Following the TCM etiology,for clinical features and pathological manifestations of modern medicine,three kinds of animal models of Yin deficiency were induced and replicated.Totally 48 Sprague-Dawley(SD) male rats were randomly divided into blank group,irritation induced model group,Fuzi-Ganjiang induced model group,and thyroxine-reserpine induced model group.After successful development of model,the ultraperformance liquid chromatography coupled to quadrupole time-of-flight mass spectrometry was carried out to detect metabolites in each group.The metabolites of rat liver were analyzed for the characteristics of their biomarkers.The pathway enrichment analysis and metabolic network construction were performed through various online databases including Metabolite Biology Role,Human Metabolome Database,MetaboAnalyst,and Kyoto Encyclopedia of Genes and Genomes.RESULTS:The SD rats in the experimental group showed symptoms like less weight gain,reduced diet and water intake,high body temperature,increased liver and kidney indexes,and abnormal liver and kidney tissue morphology.Moreover,the rats showed high increased levels of serum cyclic adenosine monophosphate,estradiol,alanine transaminase,and aspartate aminotransferase and decreased levels of cyclic guanosinc monophosphate and testosterone.We found four key interrelated metabolic pathways in the liver tissue metabolomics,including the biosynthesis of pantothenic acid and coenzyme A,and metabolism of alpha-linolenic acid metabolism,glycerophospholipid metabolism,and sphingolipid.CONCLUSION:The liver and kidney YDS is closely related to the biosynthesis of pantothenic acid and CoA and abnormal metabolism of α-linolenic acid,glycerophospholipid,and sphingolipid in SD rats.

Painful scar neuropathy:principles of diagnosis and treatment

Nerve-tissue interactions are critical.Peripheral nerve injuries may involve intraneural and extraneural scar formation and affect nerve gliding planes,sometimes leading to complex clinical presentations.All of these pathological entities involve pain as the main clinical symptom and can be subsumed under the term“painful scar neuropathy”.The authors review the literature on treatment approaches to peripheral nerve scar neuropathy and the outcomes of neurolysis-associated procedures and propose a simple classification and a therapeutic approach to scar neuropathy.The search retrieved twenty-one papers,twenty of which reported pain reduction or resolution with various techniques.There is no consensus on the best therapeutic approach to neuropathic pain due to scar tethering.Most authors report good or excellent results with different techniques,from nerve wrapping with anti-adhesion devices to nerve coverage or wrapping with vascularized tissue.The authors’classification of and therapeutic approach to peripheral nerve scar lesions aims at promoting a logical approach based on the analysis of lesion type(perineural,or endoneural and perineural),pain type(due to traction or external trauma,pain at rest),and number of previous operations.Patients need to be informed that multiple procedures may be required,that outcomes may be partial,and that surgery can potentially worsen preoperative conditions.The review found no evidence for the best therapeutic approach to scar neuropathy,but there is consensus on a multidisciplinary approach.