Peripheral sympathetic blocks

Sekhadia, Mehul; Nader, Antoun; Benzon, Honorio T.

doi:10.1016/b978-1-4377-2242-0.00088-2

Cited by 3 publications

(2 citation statements)

References 33 publications

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“…This is particularly relevant because local sympathetic blocks (e.g., via local anesthetic injections) are standard procedures in the clinic to treat some pain conditions, notably complex regional pain syndrome, but also phantom limb pain, herpes zoster and postherpetic neuralgia, ischemic pain, postmasectomy pain, and cancer pain. 9,10 The mechanisms by which sympathectomy alleviates neuropathic pain are incompletely known. Because peripheral nerve injury induces sprouting of sympathetic fibers into dorsal root ganglia, many preclinical studies focus on abnormal interactions between these fibers and sensory neurons.…”

Section: Discussionmentioning

confidence: 99%

“…8 Local sympathetic blockade is a well-accepted clinical procedure to treat various inflammatory pain conditions. 9,10 Sympathetic nerves generally promote inflammation in the initial phase of immune responses, whereas they suppress inflammation in the later phase. However, these responses are variable depending on the disease, the involved immune cell receptor, and the local environment in particular tissues.…”

Section: What This Article Tells Us That Is Newmentioning

confidence: 99%

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Local Sympathectomy Promotes Anti-inflammatory Responses and Relief of Paclitaxel-induced Mechanical and Cold Allodynia in Mice

et al. 2020

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Background Patients undergoing cancer treatment often experience chemotherapy-induced neuropathic pain at their extremities, for which there is no U.S. Food and Drug Administration–approved drug. The authors hypothesized that local sympathetic blockade, which is used in the clinic to treat various pain conditions, can also be effective to treat chemotherapy-induced neuropathic pain. Methods A local sympathectomy (i.e., cutting the ipsilateral gray rami entering the spinal nerves near the L3 and L4 dorsal root ganglia) was performed in mice receiving intraperitoneal injections every other day of the chemotherapeutic drug paclitaxel. Sympathectomy effects were then assessed in chemotherapy-induced pain-like behaviors (i.e., mechanical and cold allodynia) and neuroimmune and electrophysiologic responses. Results Local microsympathectomy produced a fast recovery from mechanical allodynia (mean ± SD: sympathectomy vs. sham at day 5, 1.07 ± 0.34 g vs. 0.51 ± 0.17g, n = 5, P = 0.030 in male mice, and 1.08 ± 0.28 g vs. 0.62 ± 0.16 g, n = 5, P = 0.036 in female mice) and prevented the development of cold allodynia in both male and female mice after paclitaxel. Mechanistically, microsympathectomy induced transcriptional increases in dorsal root ganglia of macrophage markers and anti-inflammatory cytokines, such as the transforming growth factor-β. Accordingly, depletion of monocytes/macrophages and blockade of transforming growth factor-β signaling reversed the relief of mechanical allodynia by microsympathectomy. In particular, exogenous transforming growth factor-β was sufficient to relieve mechanical allodynia after paclitaxel (transforming growth factor-β 100 ng/site vs. vehicle at 3 h, 1.21 ± 0.34g vs. 0.53 ± 0.14 g, n = 5, P = 0.001 in male mice), and transforming growth factor-β signaling regulated neuronal activity in dorsal root ganglia. Conclusions Local sympathetic nerves control the progression of immune responses in dorsal root ganglia and pain-like behaviors in mice after paclitaxel, raising the possibility that clinical strategies already in use for local sympathetic blockade may also offer an effective treatment for patients experiencing chemotherapy-induced neuropathic pain. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

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Section: Discussionmentioning

confidence: 99%

Section: What This Article Tells Us That Is Newmentioning

confidence: 99%

Local Sympathectomy Promotes Anti-inflammatory Responses and Relief of Paclitaxel-induced Mechanical and Cold Allodynia in Mice

et al. 2020

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The Antinociceptive Effect of Sympathetic Block is Mediated by Transforming Growth Factor β in a Mouse Model of Radiculopathy

et al. 2023

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The Sympathetic Nervous System and Pain

Strong

Zhang

Schaible

2018

The Oxford Handbook of the Neurobiology of Pain

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This article reviews some of the preclinical studies of the sympathetic nervous system’s role in arthritis, inflammatory, and neuropathic pain, in light of the emerging understanding of how the immune system, sensory system, and sympathetic system markedly affect each other’s function, with many mechanisms besides sprouting. Many studies show a pro-inflammatory and pro-nociceptive role for the sympathetic nerves in preclinical models. However, these studies are sometimes conflicting, and the role of the sympathetic nerves can sometimes be anti-inflammatory or anti-nociceptive, particularly at later stages or when systemic effects on immune tissues are considered. The article discusses human correlates of these preclinical studies, as well as some possible reasons for the many conflicting studies in the literature. The article argues that sympathetic-based interventions for chronic pain conditions hold promise despite the conflicting findings in the field, especially if better ways to define appropriate subsets of patients can be developed.

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Peripheral sympathetic blocks

Cited by 3 publications

References 33 publications

Local Sympathectomy Promotes Anti-inflammatory Responses and Relief of Paclitaxel-induced Mechanical and Cold Allodynia in Mice

Local Sympathectomy Promotes Anti-inflammatory Responses and Relief of Paclitaxel-induced Mechanical and Cold Allodynia in Mice

The Antinociceptive Effect of Sympathetic Block is Mediated by Transforming Growth Factor β in a Mouse Model of Radiculopathy

The Sympathetic Nervous System and Pain

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