RESUMO
Little is known about the central mechanisms underlying the transition from local or regional to widespread pain in low back pain patients. The aim of the study was to find out if muscle input induced by injection of nerve growth factor (NGF) can be used as an animal model for studying spinal mechanisms involved in widespread myofascial low back pain. Electrophysiological recordings from rat dorsal horn neurons were made in vivo to study alterations in their responsiveness caused by 2 injections of NGF into the multifidus muscle at an interval of 5 days. NGF is known to be closely associated with many painful muscle disorders. The results demonstrate that the 2 NGF injections-but not a single one-caused a significant hyperexcitability of spinal neurons. Five days after the first NGF injection, the neurons were not significantly sensitized but were easier to sensitize by a second injection. The state of the neurons resembles nociceptive priming. Important findings were that the proportion of neurons having multiple receptive fields (RFs) in various tissues was significantly higher after 2 NGF injections, and new RFs appeared on the distal hind limb. The new RFs were located not in the skin but in deep tissues (muscles, thoracolumbar fascia). If similar changes occur in patients, the data might explain the diffuse nature and spread of myofascial low back pain.
Assuntos
Músculos do Dorso/fisiopatologia , Dor Lombar/induzido quimicamente , Dor Lombar/fisiopatologia , Fator de Crescimento Neural/toxicidade , Células do Corno Posterior/fisiopatologia , Potenciais de Ação/efeitos dos fármacos , Potenciais de Ação/fisiologia , Animais , Músculos do Dorso/efeitos dos fármacos , Injeções Intramusculares , Masculino , Fator de Crescimento Neural/administração & dosagem , Limiar da Dor/efeitos dos fármacos , Limiar da Dor/fisiologia , Células do Corno Posterior/efeitos dos fármacos , Ratos , Ratos Sprague-Dawley , Tempo de Reação/fisiologia , Fatores de TempoRESUMO
La Heberkinasa® (estreptoquinasa recombinante), es un trombolítico utilizado en el tratamiento del infarto agudo del miocardio, presentada en forma de liofilizado en bulbos estériles, de conocidos y probados efectos de reperfusión coronaria y reducción del tamaño del infarto, además de otras aplicaciones como en la trombosis venosa profunda, trombosis de acceso vascular permanente de pacientes con insuficiencia renal crónica terminal tratados por hemodiálisis periódicas, disfunción de prótesis valvulares cardíacas por trombos y en el tromboembolismo pulmonar; se asocian reacciones adversas durante el tratamiento, frecuentes y menos frecuentes, dentro de las que se encuentra el dolor lumbar. Se presenta a una paciente con el diagnóstico de un infarto agudo del miocardio, de cara diafragmática, a quien se le aplicó la trombolisis con Heberkinasa y durante esta presentó dolor lumbar agudo, intenso, que cedió con la reducción de goteo de la infusión y esta se pudo continuar sin más problemas.
The Heberkinase® (recombinant streptokinase) is a thrombolytic agent used in treatment of acute myocardial infarction, presented as sterile bulbs, of known and proved effects of coronary reperfusion and reduction of infarction dimension, besides of other applications e.g. the deep venous thrombosis, permanent vascular access thrombosis in patients presenting with terminal chronic renal insufficiency treated by periodical hemodialysis, dysfunction of cardiac vascular prostheses by thrombi, and in case of pulmonary thromboembolism; there are adverse reactions associated during treatment, frequent and less frequent including those of lumbar pain. Authors present a case of a woman diagnosed with acute myocardial infarction of diaphragmatic side undergoing thrombolysis with Heberkinase, and during it she had intense and acute lumbar pain improving with reduction of dripping infusion without subsequent problems.
Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Dor Lombar/induzido quimicamente , Estreptoquinase/efeitos adversosAssuntos
Humanos , História do Século XIX , Anestesia por Condução , Anestesia por Condução/efeitos adversos , Anestesia por Condução/história , Anestesia por Condução/métodos , Anestesia por Condução/normas , Anestesia por Condução/tendências , Anestesia por Condução , Anestesia Epidural/efeitos adversos , Cefaleia/induzido quimicamente , Dor Lombar/induzido quimicamente , Embolia Aérea/induzido quimicamente , Lesão Encefálica Crônica/induzido quimicamente , Meningite/induzido quimicamenteRESUMO
We report the case of a 57-year-old male patient with severe low back pain during streptokinase infusion administered to treat typical chest pain and elevation of the ST segment in the inferior wall. We reviewed the literature, emphasizing the differential diagnosis, the pathophysiology, and management of the event.