Biomedical subjects
Publications and source records attributed to S Canavero.
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Recent evidence suggests that central pain, i.e., pain due to central nervous system damage, may be due to a deranged neurotransmission between the sensory thalamus and sensory cortical areas. Central pain can be controlled either by opposing glutamate neurotransmission or potentiating GABAergic transmission. It is speculated that a relative hypofunction of the GABAergic inhibition both at thalamic and cortical levels leads to a sectorial excitatory hypertonus in those same areas. A blend of the two should mark each patient. A pharmacological dissection approach is provided that should optimize the treatment, up to now globally poor, of central pain.
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BACKGROUND: Postoperative pain is undertreated. Lamotrigine, a new antiepileptic drug, has analgesic properties in its antisodium and antiglutamatergic effects. It may prevent postoperative pain. This pilot study assessed lamotrigine effects on postoperative pain. METHODS: This was a double-blind, randomized, placebo-controlled pilot study of 30 patients submitted to transurethral prostatectomy under spinal anesthesia and receiving 200 mg of lamotrigine 1 hour before spinal anesthesia. RESULTS: We observed a statistically significant reduction in total analgesic assumption (p < 0.01) and in visual analog scale scores at 2 (p = 0.04), 4 (p < 0.01), and 6 (p = 0.04) hours after operation. CONCLUSIONS: Lamotrigine may be an effective means of reducing postoperative pain.
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Central neurogenic pruritus is a rare symptom of central nervous system lesions, such as brain strokes, spinal tumors and multiple sclerosis. Only 26 cases appear in the literature. A further case is added. On the basis of similar features, it is speculated that central pruritus and central pain share a common origin.
A unique case of a woman with a subparietal cavernoma presenting for a time with bilateral central pain to the arms is reported. This case highlights brain mechanisms of pain processing.
Propofol, an intravenous general anaesthetic, has been reported to relieve some forms of pruritus at subhypnotic doses. We assessed its effectiveness in 32 patients with several kinds of non-malignant chronic pain, in a placebo-controlled, double-blind study. We found that central pain, but not neuropathic pain, is at least partially controlled by propofol at subhypnotic doses, without major side-effects. In particular, allodynia associated with central, but no neuropathic, pain has been completely controlled. Propofol analgesia leads to renormalization of brain metabolism as seen on single photon emission computed tomography. We conclude that propofol may help in the diagnosis of central pain, particularly in unclear cases, and also in treatment. Possible mechanisms of action are discussed.
A case of hyperacute allodynia in a patient with Schneider's syndrome is described. Allodynia was completely relieved by surgery: an irritative genesis could explain such a finding. Central pain ensued a short time later.
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In this report the authors discuss a case of central pain of spinal cord origin due to a spinal thoracic intramedullary cyst. Single-photon emission computerized tomography with technetium-99m hexamethylpropyleneamineoxime showed thalamic hypoperfusion contralateral to the affected leg. Surgical evacuation resulted in total relief of the pain and normalization of the thalamic alteration. The reader can infer from these findings that functional alterations in thalamic processing may be important in the genesis of central pain.
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