Therapy, And Neurochemical Profiling Of Cerebrospinal Fluid In Acute Posttraumatic Pain Patients

Objective1. Explore the feasibility of PC A technology used in patients with acute posttraumatic pain.2. The aim of the second part of this paper was to profile cerebrospinal fluid (CSF) matabonomic in posttraumatic pain patients by using ultra-performance liquid chromatography quadrupole time-of-flight (Q-TOF) mass spectrometry.3. The primary aim of third part was to determine the concentrations of norepinephrine (NA),3-methoxy-4-hydroxyphenylglycol (MHPG), dopamine (DA), homovanillic acid (HVA),5-hydroxyindoleacetic acid (5-HIAA), and5-hydroxytryptamine (5-HT) in the CSF and link between affective symptoms and descending pain control pathway in acute posttraumatic pain patients.Methods1. Posttraumatic pain patients with sharps injuries in their lower extremities were enrolled in this study. The first group was the pethidine analgesia posttraumatic pain group; the second group was the patient controlled analgesia (PCA) posttraumatic pain group. The Pressure Pain Threshold (PPT) from0.5cm of the wound, and resting Visual Analogue Scale (VAS) were recorded4,8,12,24,36, and48hours after trauma.2. Lower extremities posttraumatic pain patients and patients without pain were enrolled in this study. The first group consisted of patients of trauma in the lower extremities. The second group which was the control group consisted of patients without pain undergoing elective surgical procedures. VAS was assessed by the patient using a10cm visual analog scale to determine the degree of pain. Mass spectrometry analysis system was applied to identify the characteristic metabolite corresponding to the potential featured peak in database of Metlin and HMDB. PLS-DA and t test were used to identify the featured peaks.3. The first group consisted of acute posttraumatic pain patients with sharps injuries in their lower extremities. The second group was the pain-free control group for the traumatic group. CSF was collected from all patients and the concentrations of NA,3-methoxy-4-hydroxyphenylglycol (MHPG), dopamine (DA), homovanillic acid (HVA), and5-hydroxyindoleacetic acid (5-HIAA), were measured by high-performance liquid. VAS scores and short form of the McGill pain questionnaire (SF-MPQ) were recorded preoperatively before lumbar puncture for spinal anesthesia.Results1. There was no significant difference of the total length in the skin wound between posttraumatic pain and postoperative pain patients. There was significant difference (P<0.05) between the4h and8,12,24,36, and48h of VAS in PCA group and Pethidine analgesia group. There was significant difference (P<0.05) between the PPT in PCA group and PPT in Pethidine analgesia group, in8,12,24, and48hours. There are3patients with nausea, vomiting in Pethidine analgesia group; there are2patients with nausea, vomiting in PCA group. There are no significant different between the2groups. The PCA may be superior to Pethidine intramuscular injection program. 2. According to the panial least square discriminate analysis (PLS-DA) model, there were4principal components, R2Y=0.996, Q2=0.689. In all of the featured peaks, noradrenaline, retention time1.41min, molecular weight170.0817; Anandamide (18:3, n-3), retention time17.44min, molecular weight322.2715; Glutamine, retention time0.75min, molecular weight147.0761; and L-Phenylalanine, retention time0.68min, molecular weight166.0834, may have biological significance.3. In the posttraumatic pain group, lumbar CSF concentrations of NA and MHPG were significantly decreased (P<0.01) compared to the control group. The posttraumatic pain group displayed a significant negative correlation between NA and the respective total value of the SF-MPQ, SF-MPQ (affective) and visual analog scale (r=-0.388, r=-0.433and r=-0.367; P<0.05).Conclusions1. PCA can safely and effectively used in patients with acute lower limb posttraumatic pain.2. Metabolomics study of CSF in posttraumatic pain patients is feasible. Some of the important metabolites are noradrenaline, Anandamide (18:3, n-3), Glutamine, and L-Phenylalanine.3. Posttraumatic pain patient demonstrat decreased concentrations of NA in CSF, indicating that descending noradrenergic pain control pathways may be inhibited. NA is more closely related to negative affects in posttraumatic pain patients.