Meta-analysis Of The Efficiency And Brain Magnetic Resonance Studies On Patients With Neuropathic Pain

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Botulinum toxin for treatment of neuralgia:a systematic review and meta-analysisObjectiveTo evaluate the efficacy and safety of botulinum toxin A(BTX-A)for treatment of neuralgia.MethodsWe searched MEDLINE,EMBASE and COCHRANE databases to identify randomized controlled trials comparing BTX-A intervention for neuropathic pain with a control group with saline.The primary outcome was the pain scores up to 24 weeks after treatment.The secondary outcomes were hours of sleep,Short Form-36(SF-36)life quality questionnaire,and adverse reactions.We used Revman 5.2 and STATA 12.0 for data analyses.ResultsTwelve trials were included(n = 530).Pain scores in BTX-A group were significantly lower than those in saline group at 4 weeks(mean difference[MD]=-1.64,95%confidence interval[CI]=-3.215-0.07,P = 0.04),12 weeks(-1.49[-2.05,-0.93],P<0.00001)and 24 weeks(-1.61[-2.81,-0.40],P = 0.009).There was no significant difference in SF-36 and hours of sleep.There was no significant difference in the incidence of injection,pain or hematoma between the groups.The incidence of slight facial asymmetry was slightly higher in the BTX-A group(odds ratio,OR = 7.5[1.64,34.21],P= 0.009).ConclusionsThere is evidence that shows the efficacy and safety of BTX-A in the treatment of neuralgia.Of note,no significant impact on the quality of life associated with BTX-A treatment was found.Part ? Study on the content of inhibitory neurotransmitters in the brain of patients with neuropathic pain by MRSObjectiveMEGA-PRESS technique was used to measure brain inhibitory neurotransmitter content in the parietal lobe of patients with neuropathic pain before and after treatment and healthy volunteers matched with the basic data,and to compare the difference of brain inhibitory neurotransmitter content in patients with neuropathic pain and healthy people,and to evaluate the correlation between the value of the McGill Pain Questionnaire-2 score,the time of onset,and the relative content of inhibitory neurotransmitters in the parietal lobe in patients with neuropathic pain before treatment in order to investigate the inhibitory neurotransmitters mechanism during the neuropathic pain.MethodsIn this study,13 patients with neuropathic pain and 9 healthy individuals matched with basic data were included,and all patients were right-handed.The age,sex,and disease durations of all patients included in the study were counted,and the simple McGill pain questionnaire-2(SF-MPOQ-2)was used to assess the pain in all patients with neuropathic pain.We use a 3.0T Philips magnetic resonance equipment to scan the patient's brain.The steps are as follows:Firstly,three-dimensional high-resolution images were acquired by using the T1-FFE sequence,and the region of interest was located in the parietal lobe.The MRS was used to collect the populoidal inhibitory neurotransmitter data of the parietal lobe.Next,Gannet software was used to process the data obtained and calculate the relative content of brain inhibitory neurotransmitters.Finally,independent sample T test was used to compare the difference of the relative content of inhibitory neurotransmitters between patients with neuropathic pain before treatment and healthy individuals by the SPSS 21.0 software,and One-way ANOVA was used to compare the differences in the relative content of brain inhibitory neurotransmitters in patients with neuropathic pain in a year before treatment and more than one year before treatment and in healthy individuals.The last,pearman correlation analysis was used to evaluate the correlation between the McGill Pain Questionnaire-2 score,disease durations and relative content of inhibitory neurotransmitters in the parietal lobe in the neuropathic pain group before treatment.Results(1)In the parietal lobe region,there was no significant difference in the relative content of brain inhibitory neurotransmitters between neuropathy pain patients before treatment and healthy human brain(t =-0.512,P = 0.614).(2)The relative content of brain inhibitory neurotransmitters in patients with neuropathic pain within one year was significantly lower than that in healthy individuals,with statistical differences(P = 0.010).(3)The relative content of brain inhibitory neurotransmitters in patients with neuropathic pain for more than one year was significantly higher than that in healthy individuals,with statistical differences(P = 0.021).(4)The correlation analysis between the relative content of inhibitory neurotransmitters in the neuropathic pain group and the disease durations showed that the relative content of inhibitory neurotransmitters in the neuropathic pain group was significantly positively correlated with the disease durations(r = 0.723,p =0.005).(5)Correlation analysis between the relative content of inhibitory neurotransmitters in the neuropathic pain group and the SF-MPOQ-2 score showed that the relative content of inhibitory neurotransmitters in the neuropathic pain group was significantly negatively correlated with SF-MPOQ-2(r =-0.768,p = 0.002).ConclusionsThe value of inhibitory neurotransmitters in the parietal lobe was significantly reduced in patients with neuropathic pain within one year.Patients with neuropathic pain more than one year were significantly higher,and the relative content of inhibitory neurotransmitters was positively correlated with the disease durations.It has been proved in clinic that the content of inhibitory neurotransmitters in short-term neuropathic pain is obviously decreased,the inhibitory neurotransmitter in chronic long-term neuropathic pain is obviously increased,and the inhibitory neurotransmitter system is involved in the process of neuropathic pain,which would provide a new entry point for the treatment of neuropathic pain patients.