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      A novel excisional wound pain model for evaluation of analgesics in rats

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          Abstract

          Background

          Management of pain from open wounds is a growing unmet healthcare need. However, the models available to study pain from wounds or to develop analgesics for the patients suffering from them have primarily relied on incisional models. Here, we present the first characterized and validated model of open wound pain.

          Methods

          Unilateral full-skin excisional punch biopsy wounds on rat hind paws were evaluated for evoked pain using withdrawal responses to mechanical and thermal stimulation, and spontaneous pain was measured using hind paw weight distribution and guarding behavior. Evaluations were done before wounding (baseline) and 2-96 hours post-wounding. The model was validated by testing the effects of buprenorphine and carprofen.

          Results

          Pain responses to all tests increased within 2 hours post-wounding and were sustained for at least 4 days. Buprenorphine caused a reversal of all four pain responses at 1 and 4 hours post-treatment compared to 0.9% saline ( P < 0.001). Carprofen decreased the pain response to thermal stimulation at 1 ( P ≤ 0.049) and 4 hours ( P < 0.011) post-treatment compared to 0.9% saline, but not to mechanical stimulation.

          Conclusions

          This is the first well-characterized and validated model of pain from open wounds and will allow study of the pathophysiology of pain in open wounds and the development of wound-specific analgesics.

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          Most cited references35

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          Human skin wounds: a major and snowballing threat to public health and the economy.

          ABSTRACT In the United States, chronic wounds affect 6.5 million patients. An estimated excess of US$25 billion is spent annually on treatment of chronic wounds and the burden is rapidly growing due to increasing health care costs, an aging population and a sharp rise in the incidence of diabetes and obesity worldwide. The annual wound care products market is projected to reach $15.3 billion by 2010. Chronic wounds are rarely seen in individuals who are otherwise healthy. In fact, chronic wound patients frequently suffer from "highly branded" diseases such as diabetes and obesity. This seems to have overshadowed the significance of wounds per se as a major health problem. For example, NIH's Research Portfolio Online Reporting Tool (RePORT; http://report.nih.gov/), directed at providing access to estimates of funding for various disease conditions does list several rare diseases but does not list wounds. Forty million inpatient surgical procedures were performed in the United States in 2000, followed closely by 31.5 million outpatient surgeries. The need for post-surgical wound care is sharply on the rise. Emergency wound care in an acute setting has major significance not only in a war setting but also in homeland preparedness against natural disasters as well as against terrorism attacks. An additional burden of wound healing is the problem of skin scarring, a $12 billion annual market. The immense economic and social impact of wounds in our society calls for allocation of a higher level of attention and resources to understand biological mechanisms underlying cutaneous wound complications.
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            Characterization of a rat model of incisional pain.

            In this study, we developed a rat model of incisional pain. A 1-cm longitudinal incision was made through skin, fascia and muscle of the plantar aspect of the hindpaw in halothane-anesthetized rats. Withdrawal responses were measured using von Frey filaments at different areas around the wound before surgery and for the next 6 days. A cumulative pain score based on the weight bearing behavior of the animals was also utilized. The results of tests for withdrawal responses and scores based on weight bearing suggest that a surgical incision of the rat foot causes a reliable and quantifiable mechanical hyperalgesia lasting for several days after surgery. An incision that only included skin and fascia but not muscle in the foot caused less severe hyperalgesia during the initial postoperative period. Distinct areas around the wound had different withdrawal thresholds during the study period. Even remote sites as much as 10 mm from the wound showed persistent mechanical hyperalgesia. Selective denervations of the rat hindpaw prior to foot incision revealed both the sural and tibial nerves were responsible for transmitting input from the incision that produces hyperalgesia. This model should allow us to understand mechanisms of sensitization caused by surgery and investigate new therapies for postoperative pain in humans.
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              A study of the impact of leg ulcers on quality of life: financial, social, and psychologic implications.

              Leg ulcers affect probably 2.5 million persons in the United States, and their prevalence is likely to rise as the population ages. They cause considerable disability, and the cost of treating these chronic wounds is enormous. The purpose of this study was to assess the financial, social, and psychologic implications of leg ulcers. Data were collected by standardized personal interviews with 73 patients with chronic leg ulcers. The interview covered several domains that were selected to determine the impact of a leg ulcer on overall quality of life. A significant number of patients had moderate to severe symptoms, principally pain, related to the leg ulcer. Eighty-one percent believed that their mobility was adversely affected by the ulcer; the dominant predictor of impaired mobility was swelling of the leg (p < 0.001). For younger, working patients, leg ulceration was correlated with time lost from work (p < 0.001), job loss (p < 0.01), and adverse effects on finances (p < 0.02). Fifty-eight percent of patients found caring for the ulcer burdensome. There was a strong correlation between time spent on ulcer care and feelings of anger and resentment. Sixty-eight percent of patients reported that the ulcer had a negative emotional impact on their lives, including feelings of fear, social isolation, anger, depression, and negative self-image. Leg ulcers pose a substantial threat to a variety of dimensions of a patient's quality of life.
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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 2021
                1 April 2021
                : 34
                : 2
                : 165-175
                Affiliations
                [1]Vapogenix Inc., Houston, TX, USA
                Author notes
                Correspondence Sergio Parra, Vapogenix Inc., 8285 El Rio St, Suite 170, Houston, TX 77054, USA, Tel: +1-713-748-3903 x 227, Fax: +1-800-779-2906, E-mail: Protean1974@ 123456yahoo.com

                Handling Editor: Jong Yeon Park

                [*]

                These authors contributed equally to this work.

                Author information
                https://orcid.org/0000-0002-3191-0475
                https://orcid.org/0000-0002-4774-5937
                https://orcid.org/0000-0001-7412-3140
                https://orcid.org/0000-0002-0341-5602
                Article
                kjp-34-2-165
                10.3344/kjp.2021.34.2.165
                8019955
                33785668
                a65746d3-ffc6-4335-92e6-fc3ef7178ad3
                © The Korean Pain Society, 2021

                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
                : 26 August 2020
                : 27 October 2020
                : 3 November 2020
                Categories
                Experimental Research Articles

                Anesthesiology & Pain management
                analgesics,biopsy,hyperalgesia,models, animal,nociceptive pain,pain management,pain, procedural,rats,wound and injuries

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