Pain in tropical spastic paraparesis/HTLV-I associated myelopathy patients

Abstract

-Objective: Tropical Spastic Paraparesis/HTLV-I Associated Myelopathy (TSP/HAM) is a chronic myelopathy, and pain has been mentioned as a frequent sensory symptom in this condition. The authors aimed at analyzing this symptom in a TSP/HAM patients series. Method: For this, 46 patients were analyzed considering demographic and clinical characteristics and complaint of pain as to verbal description, time of onset and classification, correlated with the degree of motor disability and type of pain. Results: Among the 46 TSP/HAM patients, 28 (60.8%) complained of pain, predominant in the early phase of the disease. Most of the patients exhibited neuropathic characteristics of pain, correlated with increased motor disability. Conclusion: Pain in TSP/HAM patients is a frequent and early symptom, and the neuropathic type is predominant (57.1%) and paralleled with increased incapacitation. The pathogenic involvement of cytokines may possibly be involved in the meaning of this symptom in this condition.Key wordS: TSP/HAM, HTLV-I, pain, inflammatory nociceptive and neuropathic, cytokines.dor em pacientes com paraparesia espástica tropical/mielopatia associada ao HTlV-i resumo -Objetivo: A Paraparesia espástica Tropical/Mielopatia Associada ao HTLV-I (PeT/MAH) é uma mielopatia crônica, e a dor tem sido mencionada como um sintoma sensitivo freqüente nessa condição. os autores objetivam analisar esse sintoma numa série de pacientes com PeT/MAH. Método: Para isso, 46 pacientes foram analisados considerando características demográficas e clínicas, e queixa de dor do ponto de vista da descrição verbal, tempo de início e classificação, correlacionados com o grau de incapacitação motora e o tipo de dor. Resultados: dentre os 46 pacientes com PeT/MAH, 28 (60,8%) se queixavam de dor, predominando na fase inicial da doença. A maioria dos pacientes evidenciou características de dor neuropática, correlacionada com aumento da incapacitação motora. Conclusão: A dor em pacientes com PeT/MAH é um sintoma freqüente e inicial, sendo o tipo neuropático predominante (57,1%) e em paralelo com maior incapacitação. o envolvimento patogênico das citocinas poderá possivelmente estar relacionado com o significado desse sintoma nessa condição clínica.PALAVrAS-CHAVe: PeT/MAH, HTLV-I, dor, nociceptiva inflamatória e neuropática, citocinas.

Effects of tDCS-induced Motor Cortex Modulation on Pain in HTLV-1

“…Recent experiments are testing the use of topically applied anesthetics before tDCS as to decrease minimal pain and itching associated with the effects of the electrical current, thus to decrease placebo response. 6 In addition, as it has been demonstrated in other chronic low back pain syndromes, 41 supraspinal neuroplastic changes might also take part in chronic pain mechanisms in HTLV-1 infection. Previous studies have shown that a high proportion of these patients have chronic low back and/or lower limbs pain of mixed origin.…”

“…In fact, a recent clinical trial showed that blinding effectiveness of tDCS was similar to placebo pills-the gold standard of blinding method. [6][7][8] In general, there is no overall preponderance of neuropathic over nociceptive pain; nevertheless, when superimposed, neuropathic pain characteristics are usually more disabling. Recent experiments are testing the use of topically applied anesthetics before tDCS as to decrease minimal pain and itching associated with the effects of the electrical current, thus to decrease placebo response.…”

“…1 Some patients infected with this virus present motor, sensory, and autonomic functional deficits. [6][7][8] One study found that >84.5% of HTLV-1infected patients reported chronic pain, having an incapacitating effect in most of the cases. [6][7][8] One study found that >84.5% of HTLV-1infected patients reported chronic pain, having an incapacitating effect in most of the cases.…”

“…[6][7][8] One study found that >84.5% of HTLV-1infected patients reported chronic pain, having an incapacitating effect in most of the cases. 6,8 Given the central changes associated with this condition, current analgesic therapies commonly fail to provide sufficient relief for chronic pain. 6,8 Given the central changes associated with this condition, current analgesic therapies commonly fail to provide sufficient relief for chronic pain.…”

HTLV-1, Immune Response and Autoimmunity

“…The HTLV-1-infected CD4 + T lymphocytes of HAM/TSP patients exhibit spontaneous proliferation, in addition to an increased production of proinflammatory cytokines such as IFN-γ, TNF-α, IL-1, and IL-6; neurotoxic cytokines such as IFN-γ and TNF-α, in particular, are found at high concentrations in the spinal fluid of HAM/TSP patients [ 9 , 16 , 50 , 51 ]. These findings demonstrate that infected individuals have an immune response characteristic of the Th1 phenotype (IFN-γ and TNF-α) and a decrease in the Th2 profile (IL-4 and IL-10) [ 30 , 31 , 45 ].…”