Mast Cells: A New Target in the Treatment of Complex Regional Pain Syndrome?

Pain Practice

1. Maaike Dirckx MD^1,*, 
2. George Groeneweg PT, PhD¹, 
3. Paul L. A. van Daele MD, PhD²,
4. Dirk L. Stronks PhD¹, 
5. Frank J. P. M. Huygen MD, PhD¹

Article first published online: 14 MAR 2013

DOI: 10.1111/papr.12049

Abstract

There is convincing evidence that inflammation plays a pivotal role in the pathophysiology of complex regional pain syndrome (CRPS). Besides inflammation, central sensitization is also an important phenomenon. Mast cells are known to be involved in the inflammatory process of CRPS and also play a role (at least partially) in the process of central sensitization. In the development of a more mechanism-based treatment, influencing the activity of mast cells might be important in the treatment of CRPS. We describe the rationale for using medication that counteracts the effects of mast cells in the treatment of CRPS.

Headache during airplane travel (“airplane headache”): first case in Greece

The Journal of Headache and Pain
Official Journal of the "European Headache Federation" and of "Lifting The Burden - The Global Campaign against Headache"
Evangelia Kararizou¹ , Evangelos Anagnostou¹, George P. Paraskevas¹, Sofia D. Vassilopoulou¹, Dimitrios Naoumis², Grigoris Kararizos² and Konstantinos Spengos¹

(1)	Department of Neurology, Athens National University, Eginition Hospital, 72-74 Vas.Sofias av., 11528 Athens, Greece

(2)	Neurological Department, 251 Air Force Hospital, Athens, Greece

Evangelia Kararizou Email: ekarariz@med.uoa.gr

Received: 21 February 2011  Accepted: 22 March 2011  Published online: 6 April 2011

Abstract  

Headache related to airplane flights is rare. We describe a 37-year-old female patient with multiple intense, jabbing headache episodes over the last 3 years that occur exclusively during airplane flights. The pain manifests during take-off and landing, and is located always in the left retro-orbital and frontotemporal area. It is occasionally accompanied by dizziness, but no additional symptoms occur. Pain intensity diminishes and disappears after 15–20 min. Apart from occasional dizziness, no other symptoms occur. The patient has a history of tension-type headache and polycystic ovaries. Blood tests and imaging revealed no abnormalities. Here, we present the first case in Greece. We review the current literature on this rare syndrome and discuss on possible pathophysiology and the investigation of possible co-factors such as anxiety and depression.

http://www.springerlink.com/content/t86630777t603224/fulltext.html

Free Full Text (Open Access): 

Advances in Neuropathic Pain Diagnosis, Mechanisms, and Treatment Recommendations

Arch Neurol. 2003;60:1524-1534.
Robert H. Dworkin, PhD; Miroslav Backonja, MD; Michael C. Rowbotham, MD; Robert R. Allen, MD; Charles R. Argoff, MD; Gary J. Bennett, PhD; M. Catherine Bushnell, PhD; John T. Farrar, MD; Bradley S. Galer, MD; Jennifer A. Haythornthwaite, PhD; David J. Hewitt, MD; John D. Loeser, MD; Mitchell B. Max, MD; Mario Saltarelli, MD, PhD; Kenneth E. Schmader, MD; Christoph Stein, MD; David Thompson, PhD; Dennis C. Turk, PhD; Mark S. Wallace, MD; Linda R. Watkins, PhD; Sharon M. Weinstein, MD

ABSTRACT
Chronic neuropathic pain, caused by lesions in the peripheral or central nervous system, comes in many forms. We describe current approaches to the diagnosis and assessment of neuropathic pain and discuss the results of recent research on its pathophysiologic mechanisms. Randomized controlled clinical trials of gabapentin, the 5% lidocaine patch, opioid analgesics, tramadol hydrochloride, and tricyclic antidepressants provide an evidence-based approach to the treatment of neuropathic pain, and specific recommendations are presented for use of these medications. Continued progress in basic and clinical research on the pathophysiologic mechanisms of neuropathic pain may make it possible to predict effective treatments for individual patients by application of a pain mechanism–based approach. An evidence-based treatment approach is becoming feasible as the number of published randomized controlled trials continues to grow steadily. In this article, we discuss the diagnosis and assessment of neuropathic pain and survey recent research on pathophysiologic mechanisms. Evidence-based treatment recommendations for the pharmacologic management of chronic neuropathic pain are presented that take into account clinical effectiveness, adverse effects, influence on quality of life, and cost.

Free Full Text: http://archneur.ama-assn.org/cgi/content/full/60/11/1524