martes, 8 de agosto de 2017

Dolor / Pain

Agosto 1, 2017. No. 2767


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Formación reticular y dolor: El pasado y el futuro.
Reticular Formation and Pain: The Past and the Future.
Martins I1,2,3,4, Tavares I1,2,3,4.
Front Neuroanat. 2017 Jul 5;11:51. doi: 10.3389/fnana.2017.00051. eCollection 2017.
The involvement of the reticular formation (RF) in the transmission and modulation of nociceptive information has been extensively studied. The brainstem RF contains several areas which are targeted by spinal cord afferents conveying nociceptive input. The arrival of nociceptive input to the RF may trigger alert reactions which generate a protective/defense reaction to pain. RF neurons located at the medulla oblongata and targeted by ascending nociceptive information are also involved in the control of vital functions that can be affected by pain, namely cardiovascular control. The RF contains centers that belong to the pain modulatory system, namely areas involved in bidirectional balance (decrease or enhancement) of pain responses. It is currently accepted that the imbalance of pain modulation towards pain facilitation accounts for chronic pain. The medullary RF has the peculiarity of harboring areas involved in bidirectional pain control namely by the existence of specific neuronal populations involved in antinociceptive or pronociceptive behavioral responses, namely at the rostroventromedial medulla (RVM) and the caudal ventrolateral medulla (VLM). Furthermore the dorsal reticular nucleus (also known as subnucleus reticularis dorsalis; DRt) may enhance nociceptive responses, through a reverberative circuit established with spinal lamina I neurons and inhibit wide-dynamic range (WDR) neurons of the deep dorsal horn. The components of the triad RVM-VLM-DRt are reciprocally connected and represent a key gateway for top-down pain modulation. The RVM-VLM-DRt triad also represents the neurobiological substrate for the emotional and cognitive modulation of pain, through pathways that involve the periaqueductal gray (PAG)-RVM connection. Collectively, we propose that the RVM-VLM-DRt triad represents a key component of the "dynamic pain connectome" with special features to provide integrated and rapid responses in situations which are life-threatening and involve pain. The new available techniques in neurobiological studies both in animal and human studies are producing new and fascinating data which allow to understand the complex role of the RF in pain modulation and its integration with several body functions and also how the RF accounts for chronic pain.
KEYWORDS: analgesics; cognition; connectome; emotions; noradrenaline; opioids; serotonin

Avances recientes en la comprensión y manejo del dolor por cáncer.
Recent advances in understanding and managing cancer pain.
F1000Res. 2017 Jun 20;6:945. doi: 10.12688/f1000research.10817.1. eCollection 2017.Abstract
Cancer pain remains a significant clinical problem worldwide. Causes of cancer pain are multifactorial and complex and are likely to vary with an array of tumor-related and host-related factors and processes. Pathophysiology is poorly understood; however, new laboratory research points to cross-talk between cancer cells and host's immune and neural systems as an important potential mechanism that may be broadly relevant to many cancer pain syndromes. Opioids remain the most effective pharmaceuticals used in the treatment of cancer pain. However, their role has been evolving due to emerging awareness of risks of chronic opioid therapy. Despite extensive research efforts, no new class of analgesics has been developed. However, many potential therapeutic targets that may lead to the establishment of new pharmaceuticals have been identified in recent years. It is also expected that the role of non-pharmacological modalities of treatment will grow in prominence. Specifically, neuromodulation, a rapidly expanding field, may play a major role in the treatment of neuropathic cancer pain provided that further technological progress permits the development of non-invasive and inexpensive neuromodulation techniques.
KEYWORDS: biology of cancer pain; cancer pain; cancer-induced bone pain; cannabis; chemotherapy-induced peripheral neuropathy; intrathecal analgesia; medical marijuana; neuromodulation; opioids; scrambler therapy; spinal cord stimulation
El Comité Ejecutivo de la IASP insta a Venezuela a centrarse en el acceso a medicamentos para el dolor a la luz de escasez crítica
IASP Executive Committee Urges Venezuela to Focus on Access to Pain Medications in Light of Critical Shortages
As the leading global organization that brings together scientists, clinicians, health-care providers, and policymakers to stimulate and support the study of pain with the goal of improved pain relief worldwide, the International Association for the Study of Pain (IASP) has been made aware that difficult conditions in Venezuela have resulted in inadequate access to pain treatment.

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Octubre 1-Diciembre 31, 2017
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