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      Increased calcium-mediated cerebral processes after peripheral injury: possible role of the brain in complex regional pain syndrome

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          Abstract

          Background

          Among various diseases that accompany pain, complex regional pain syndrome (CRPS) is one of the most frustrating for patients and physicians. Recently, many studies have shown functional and anatomical abnormalities in the brains of patients with CRPS. The calcium-related signaling pathway is important in various physiologic processes via calmodulin (CaM) and calcium-calmodulin kinase 2 (CaMK2). To investigate the cerebral mechanism of CRPS, we measured changes in CaM and CaMK2 expression in the cerebrum in CRPS animal models.

          Methods

          The chronic post-ischemia pain model was employed for CRPS model generation. After generation of the animal models, the animals were categorized into three groups based on changes in the withdrawal threshold for the affected limb: CRPS-positive (P), CRPS-negative (N), and control (C) groups. Western blot analysis was performed to measure CaM and CaMK2 expression in the rat cerebrum.

          Results

          Animals with a decreased withdrawal threshold (group P) showed a significant increment in cerebral CaM and CaMK2 expression ( P = 0.013 and P = 0.021, respectively). However, groups N and C showed no difference in CaM and CaMK2 expression.

          Conclusions

          The calcium-mediated cerebral process occurs after peripheral injury in CRPS, and there can be a relationship between the cerebrum and the pathogenesis of CRPS.

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          Most cited references37

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          Function and regulation of CREB family transcription factors in the nervous system.

          CREB and its close relatives are now widely accepted as prototypical stimulus-inducible transcription factors. In many cell types, these factors function as effector molecules that bring about cellular changes in response to discrete sets of instructions. In neurons, a wide range of extracellular stimuli are capable of activating CREB family members, and CREB-dependent gene expression has been implicated in complex and diverse processes ranging from development to plasticity to disease. In this review, we focus on the current level of understanding of where, when, and how CREB family members function in the nervous system.
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            Central sensitization and LTP: do pain and memory share similar mechanisms?

            Synaptic plasticity is fundamental to many neurobiological functions, including memory and pain. Central sensitization refers to the increased synaptic efficacy established in somatosensory neurons in the dorsal horn of the spinal cord following intense peripheral noxious stimuli, tissue injury or nerve damage. This heightened synaptic transmission leads to a reduction in pain threshold, an amplification of pain responses and a spread of pain sensitivity to non-injured areas. In the cortex, LTP - a long-lasting highly localized increase in synaptic strength - is a synaptic substrate for memory and learning. Analysis of the molecular mechanisms underlying the generation and maintenance of central sensitization and LTP indicates that, although there are differences between the synaptic plasticity contributing to memory and pain, there are also striking similarities.
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              The brain in chronic CRPS pain: abnormal gray-white matter interactions in emotional and autonomic regions.

              Chronic complex regional pain syndrome (CRPS) is a debilitating pain condition accompanied by autonomic abnormalities. We investigated gray matter morphometry and white matter anisotropy in CRPS patients and matched controls. Patients exhibited a disrupted relationship between white matter anisotropy and whole-brain gray matter volume; gray matter atrophy in a single cluster encompassing right insula, right ventromedial prefrontal cortex (VMPFC), and right nucleus accumbens; and a decrease in fractional anisotropy in the left cingulum-callosal bundle. Reorganization of white matter connectivity in these regions was characterized by branching pattern alterations, as well as increased (VMPFC to insula) and decreased (VMPFC to basal ganglion) connectivity. While regional atrophy differentially related to pain intensity and duration, the strength of connectivity between specific atrophied regions related to anxiety. These abnormalities encompass emotional, autonomic, and pain perception regions, implying that they likely play a critical role in the global clinical picture of CRPS.
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                Author and article information

                Journal
                Korean J Pain
                Korean J Pain
                The Korean Journal of Pain
                The Korean Pain Society
                2005-9159
                2093-0569
                1 April 2020
                1 April 2020
                1 April 2020
                : 33
                : 2
                : 131-137
                Affiliations
                [1 ]Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
                [2 ]Department of Anesthesiology and Pain Medicine, College of Medicine, Seoul National University, Seoul, Korea
                [3 ]Department of Veterinary Medicine, College of Veterinary Medicine, Konkuk University, Seoul, Korea
                Author notes
                Correspondence Sang-Soep Nahm, Department of Veterinary Medicine, College of Veterinary Medicine, Konkuk University, 120 Neungdong-ro, Gwangjingu, Seoul 05029, Korea, Tel: +82-2-450-3705, Fax: +82-2-450-3037, E-mail: ssnahm@ 123456konkuk.ac.kr

                Author contributions: Francis Sahngun Nahm: Writing/manuscript preparation; Jae-Sung Lee: Computation; Pyung-Bok Lee: Writing/manuscript preparation; Eunjoo Choi: Writing/manuscript preparation; Woong Ki Han: Writing/manuscript preparation; Sang-Soep Nahm: Supervision.

                Author information
                https://orcid.org/0000-0002-5900-7851
                https://orcid.org/0000-0002-2469-484X
                https://orcid.org/0000-0003-0325-3356
                https://orcid.org/0000-0002-7002-3932
                https://orcid.org/0000-0002-6894-9787
                https://orcid.org/0000-0002-0519-580X
                Article
                KJP-33-131
                10.3344/kjp.2020.33.2.131
                7136292
                32235013
                95b5ebb2-b7c1-48d1-8c49-530800c00382
                © The Korean Pain Society, 2020

                This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/4.0), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 3 February 2020
                : 28 February 2020
                : 5 March 2020
                Categories
                Original Article

                Anesthesiology & Pain management
                blotting, western,brain,calcium-calmodulin-dependent protein kinases,calmodulin,cerebrum,complex regional pain syndromes,pain,rats

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