Finding Possible Neuropathy Treatments By Examining The Spinal Cord

Today's post from sites.utoronto.ca (see link below) is a complex one for the lay reader but maybe you should give it a go anyway, even if you don't understand everything it says. The point is that it gives us as patients, an insight into how scientists are looking into our problems and trying to come up with solutions. It's like peeking through the keyhole and learning something new about what may be coming in the future, something which in itself can make us feel better about our condition because at least we know something is being done! Basically, the scientists here placed electrodes on the spinal cord at different places and measured the electronic activity of the nerve cells simultaneously. In this way they were able to identify where things were breaking down and could block nerve signals if they were causing pain. It's much more complex than this simplistic explanation of course but the potential for future treatments at source, using this sort of intervention, is enormous. Remember as long as you get a vague picture in your mind of what's going on, you're increasing your understanding of neuropathy at the same time.

Different Mechanisms of Spinal Cord Neuron Disinhibition in Neuropathic Pain Models Require Different Therapeutic Interventions
Posted on 18-09-2015 
 
Exciting new research from Dr. Steven Prescott’s lab is working to bridge the gap between basic research on neuropathic pain etiology to possible clinical interventions to treat neuropathic pain. Dr. Steven Prescott is a UTCSP member and scientist at the Hospital for Sick Children. In this paper, lead author Dr. Kwan Lee uses a unique method to measure intact spinal cord neurons from alive, anaesthetized animals, overcoming disadvantages of ex-vivo methodologies. To do this, Dr. Lee placed an array of 16 recording electrodes into the superficial spinal cord, and was able to record the electrical activity of 16 neurons simultaneously.

Using this method, Dr. Lee found that two competing mechanisms of disinhibition (blockade of inhibition that yields net neuronal excitation) of these neurons yielded almost indistinguishable phenotypes, but were differentially sensitive to different pharmacological treatments. First, he blocked the potassium chloride co-transporter KCC2 using DIOA, which leads to a dysregulation of chloride in inhibitory neurons, and thus disinhibition. This resulted in allodynia in the animal, or an increase in response to a previously innocuous brush stimulus. Using the drug ACTZ, he was able to compensate for chloride dysregulation, and restore inhibition, bringing responses to brush stimulus back down to baseline.

Then, when Dr. Lee initiated disinhibition through blockade of GABAA receptors, again yielding increased neuronal responses to brush stimulus, ACTZ was not able to reduce these aberrant neuronal responses to previously innocuous brush stimuli. This indicates that two different forms of disinhibition that lead to the same measurable phenotype of neuropathic pain react differently to pharmacological interventions. This suggests that there should be a shift in the medical field to identifying biomarkers of neuropathic pain etiology or trying several potential treatments before selecting the specific therapeutic intervention for neuropathic pain patients, in order to best treat their symptoms.

To read this article, please visit: http://www.ncbi.nlm.nih.gov/pubmed/?term=26186265

Reference: Lee, KY, Prescott, SA. Chloride dysregulation and inhibitory receptor blockade yield equivalent disinhibition of spinal neurons yet are differentially reversed by carbonic anhydrase blockade. Pain. July, 2015.

http://sites.utoronto.ca/pain/research/articles/684.html

Spinal Electro Stimulation For Neuropathy

Today's short article from poz.com discusses a recent small trial of electrical spinal stimulation procedures to help severe neuropathic symptoms. It is an operative procedure wherein permanent electrodes are inserted into a segment of the spine. It sounds slightly scary and is a relatively new method for neuropathy but is a well-established technique used for treating other conditions. You do wonder if it's a one size fits all approach or if it is only effective for specific forms of nerve damage. More information and larger trials are sure to follow but it sounds promising. It may be worth discussing the possibility of joining a trial, with your doctor or neurologist, especially if you haven't had any success with the medications. However, there may be cost issues, or plain lack of knowledge to deal with.

Spinal Cord Stimulation Shows Potential for Peripheral Neuropathy
February 7, 2012

Electrical stimulation of the spinal cord markedly reduced peripheral neuropathy (PN)–associated pain in a man living with HIV who didn’t respond to more conventional PN therapies, according to a February 5 presentation at the 6th World Congress of the World Institute of Pain in Miami and reported by Medscape.

Data involving another five patients enrolled in the study, being conducted by Kenneth Candido, MD, of the Advocate Illinois Masonic Medical Center in Chicago and his colleagues, are awaited, but the researchers are encouraged by the results they’ve seen thus far. “We believe that it is not only a new indication, but it offers relief for individuals who were previously left to the devices of primary care physicians who really only have at their disposal the ability to prescribe narcotic analgesics,” Candido said.

Treatment initially involved temporary placement of two leads, each containing eight electrodes, into a segment of the spine. Once the electric stimulation proved safe and effective, permanent electrodes were placed by the study investigators.

The study volunteer highlighted by Candido’s group at the Miami conference was a 50-year-old man who had been living with HIV for 20 years and had an eight-year history of “excruciating” neuropathic pain and burning sensations, notably on the soles of his feet. He had not responded to other available neuropathy treatments, such as narcotic and non-narcotic pain relievers, anti-seizure drugs and nerve blocks.

The results thus far have been encouraging, Candido told Medscape. “He has now had almost two years of reduction in his pain, from a constant level of about 8 out of 10 down to about 1 or 2 out of 10, and we’ve been able to wean him off his [narcotic pain relievers],” he said.

Spinal cord stimulation is a well-established technique currently indicated for the management of failed back surgery syndrome, complex regional pain syndrome, inoperable peripheral vascular disease, and refractory angina pectoris.

http://www.poz.com/articles/hiv_spinal_neuropathy_761_21869.shtml

Spinal Manipulation For Chronic Pain

Today's post from sciencedaily.com (see link below) looks at spinal manipulative therapy (SMT) as a means of reducing chronic pain in the back. central spinal sensitization is also a factor in peripheral neuropathic problems and SMT may also be able to play a role in lessening neuropathic pain too. The post is generally aimed at low back pain sufferers but it's an interesting read for all those living with chronic pain.

Spinal manipulative therapy reduces central pain sensitization 
Date:
February 25, 2014
Source:
American Pain Society

The lessening of pain sensitivity achieved with spinal manipulation therapy (SMT) occurs as a result of the treatment and not as much from a placebo effect caused by the expectation of receiving SMT. Chronic low back pain is associated with altered pain processing, suggesting a mechanism related to central sensitization of pain. Central sensitization is considered a factor in the progression of acute pain to chronic pain and in the maintenance of chronic pain.

The lessening of pain sensitivity achieved with spinal manipulation therapy (SMT) occurs as a result of the treatment and not as much from a placebo effect caused by the expectation of receiving SMT, according to a study published in The Journal of Pain.

Spinal manipulative therapy has been shown to reduce the severity of low back pain in some patients. Improved understanding of its pain-relieving mechanisms could enhance clinical effectiveness.

Chronic low back pain is associated with altered pain processing, suggesting a mechanism related to central sensitization of pain. Central sensitization is considered a factor in the progression of acute pain to chronic pain and in the maintenance of chronic pain.

Researchers from the University of Florida investigated whether lessening of pain sensitivity attributed to SMT is specific to the procedure itself or occurs as a placebo effect from treatment expectation. Studies have shown that placebo is associated with robust analgesia produced by anticipation of pain relief.

Subjects for the study had low back pain and were recruited from the University of Florida campus. Participants underwent baseline pressure and thermal pain testing and were randomly assigned to SMT, placebo SMT, enhanced placebo SMT (same as placebo SMT except subjects were informed they would get SMT or a placebo intervention) or no intervention. The 110 study subjects had repeat mechanical and thermal pain sensitivity testing to measure immediate, within session, change in pain sensitivity.

Results showed that significantly more participants receiving the enhanced placebo SMT indicated good to excellent outcomes than those receiving standard placebo SMT or no treatment. A significant difference was not found between subjects receiving SMT and the enhanced placebo.

The authors concluded their findings reveal a mechanism of SMT unrelated to the expectation of receiving SMT, but from modulation of dorsal horn excitability and lessening of central sensitization. This suggests potential for SMT to be a clinically beneficial intervention.

Story Source:

The above story is based on materials provided by American Pain Society. Note: Materials may be edited for content and length.

Journal Reference:
Joel E. Bialosky, Steven Z. George, Maggie E. Horn, Donald D. Price, Roland Staud, Michael E. Robinson. Spinal Manipulative Therapy–Specific Changes in Pain Sensitivity in Individuals With Low Back Pain (NCT01168999). The Journal of Pain, 2014; 15 (2): 136 DOI: 10.1016/j.jpain.2013.10.005
 
http://www.sciencedaily.com/releases/2014/02/140225122220.htm

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Neuropathy Knowledge What Is The Spinal Cord

Today's post from sciencedaily.com (see link below) is the fifth part of a series from the same source providing readers with explanations and information about many of the medical terms they hear when researching neuropathy, or sitting in the doctor's surgery and talking about it. Today it explains how the 'spinal cord' works and gives related definitions of other words associated with its importance in the body. Worth following the links if you have the time.

Spinal cord
Science Daily via Wikipedia

The spinal cord is a part of the vertebrate nervous system that is enclosed in and protected by the vertebral column (it passes through the spinal canal).

It consists of nerve cells.

The cord conveys the 31 spinal nerve pairs of the peripheral nervous system, as well as central nervous system pathways that innervate skeletal muscles.

For more information about the topic Spinal cord, read the full article at Wikipedia.org, or see the following related articles:


Peripheral nervous system — The peripheral nervous system or PNS, is part of the nervous system, and consists of the nerves and neurons that reside or extend outside the central ...  read more


Central nervous system — The central nervous system (CNS) represents the largest part of the nervous system, including the brain and the spinal cord. Together with the ...  read more


Motor neuron — In vertebrates, motor neurons (also called motoneurons) are efferent neurons that originate in the spinal cord and synapse with muscle fibers to ... read more


Sensory neuron — Sensory neurons are nerve cells within the nervous system responsible for converting external stimuli from the organism's environment into internal ...  read more


Sympathetic nervous system — The sympathetic nervous system (SNS) is part of the autonomic nervous system (ANS), which also includes the parasympathetic nervous system (PNS). The ...  read more


Phantom limb — Phantom limb is a phantom sensation in amputated or missing limbs. A phantom sensation is a feeling that a missing limb is still attached to the body ... read more


Nociceptor — A nociceptor is a sensory receptor that sends signals that cause the perception of pain in response to potentially damaging stimulus. Nociceptors are ...  read more


Spina bifida — Spina bifida describes birth defects caused by an incomplete closure of one or more vertebral arches of the spine, resulting in malformations of the ...  read more


Nervous system — The nervous system of an animal coordinates the activity of the muscles, monitors the organs, constructs and also stops input from the senses, and ...  read more


Parasympathetic nervous system — The parasympathetic nervous system is one of three divisions of the autonomic nervous system. Sometimes called the rest and digest system, the ... read more


http://www.sciencedaily.com/articles/s/spinal_cord.htm

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