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  1. Article ; Online: A case of severe trigeminal neuralgia

    Cristina Afi Lopes / Lorenz Fischer

    Journal of International Medical Research, Vol

    recovery by means of stellate ganglion block with procaine. Discussion of possible mechanisms of action

    2023  Volume 51

    Abstract: Drug and invasive treatment options for trigeminal neuralgia (TN) are often fraught with problems. Knowledge of the involvement of the autonomic nervous system, especially the sympathetic portion, in the pain process has grown rapidly in recent years. ... ...

    Abstract Drug and invasive treatment options for trigeminal neuralgia (TN) are often fraught with problems. Knowledge of the involvement of the autonomic nervous system, especially the sympathetic portion, in the pain process has grown rapidly in recent years. Both nociceptive and neuropathic pain can be maintained by the sympathetic nervous system, known as ‘sympathetically maintained pain’ (SMP). This current case report describes a patient with refractory TN that was treated with a stellate ganglion block (SGB). After the first SGB, the patient experienced significant pain relief that became long-lasting after repeated application of the SGB. These findings suggest that this patient had a high level of SMP. In patients with a low percentage of SMP, SGB may be less or not successful. A literature search did not find any case reports or studies about patients with refractory idiopathic TN treated with sympathetic blocks using local anaesthetics. From our point of view, it might be useful to test by means of SGB the extent to which an individual has SMP present, and, if that is the case, to perform a short series of SGB, as done in this current patient. Studies are needed to provide further insights.
    Keywords Medicine (General) ; R5-920
    Subject code 616
    Language English
    Publishing date 2023-04-01T00:00:00Z
    Publisher SAGE Publishing
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  2. Article ; Online: Therapeutic Use of Low-Dose Local Anesthetics in Pain, Inflammation, and Other Clinical Conditions

    David Vinyes / Montserrat Muñoz-Sellart / Lorenz Fischer

    Journal of Clinical Medicine, Vol 12, Iss 23, p

    A Systematic Scoping Review

    2023  Volume 7221

    Abstract: The use of low-dose local anesthetics (LAs) has significantly transformed patient care by providing rapid and effective relief of pain and other clinical conditions while minimizing recovery time. This study aims to identify and describe the existing ... ...

    Abstract The use of low-dose local anesthetics (LAs) has significantly transformed patient care by providing rapid and effective relief of pain and other clinical conditions while minimizing recovery time. This study aims to identify and describe the existing scientific evidence on the therapeutic use of low-dose LAs in various conditions and to identify gaps in the current literature in order to prioritize future research. This systematic scoping review adhered to the methodological guidelines outlined in the Arksey and O’Malley framework, which includes five distinct stages. Of the 129 studies included, 37.98% ( n = 49) were clinical trials, 55.03% ( n = 71) were observational studies, and 6.97% ( n = 9) were systematic reviews. The most commonly reported indication for the use of low-dose LAs was chronic pain management (72.86%), followed by acute pain management (13.17%). Additionally, non-pain-related indications were also identified (13.95%). Overall, the administration of low-dose, short-acting LAs demonstrated favorable outcomes in terms of pain management and reduction in anxiety and depression scales, thereby having a positive impact on the patients’ quality of life. This review represents the first systematic scoping review regarding the therapeutic role of LAs. To substantiate the reported positive effects on efficacy and safety, further rigorous research comprising larger, well-designed randomized controlled trials (RCTs) and long-term outcome monitoring is imperative.
    Keywords local anesthetics ; pain ; neural therapy ; therapeutic local anesthesia ; procaine ; lidocaine ; Medicine ; R
    Subject code 610
    Language English
    Publishing date 2023-11-01T00:00:00Z
    Publisher MDPI AG
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  3. Article ; Online: Investigation of the Sympathetic Regulation in Delayed Onset Muscle Soreness

    Johannes Fleckenstein / Elmo W. I. Neuberger / Philipp Bormuth / Fabio Comes / Angelika Schneider / Winfried Banzer / Lorenz Fischer / Perikles Simon

    Frontiers in Physiology, Vol

    Results of an RCT

    2021  Volume 12

    Abstract: Sports-related pain and injury is directly linked to tissue inflammation, thus involving the autonomic nervous system (ANS). In the present experimental study, we disable the sympathetic part of the ANS by applying a stellate ganglion block (SGB) in an ... ...

    Abstract Sports-related pain and injury is directly linked to tissue inflammation, thus involving the autonomic nervous system (ANS). In the present experimental study, we disable the sympathetic part of the ANS by applying a stellate ganglion block (SGB) in an experimental model of delayed onset muscle soreness (DOMS) of the biceps muscle. We included 45 healthy participants (female 11, male 34, age 24.16 ± 6.67 years [range 18–53], BMI 23.22 ± 2.09 kg/m2) who were equally randomized to receive either (i) an SGB prior to exercise-induced DOMS (preventive), (ii) sham intervention in addition to DOMS (control/sham), or (iii) SGB after the induction of DOMS (rehabilitative). The aim of the study was to determine whether and to what extent sympathetically maintained pain (SMP) is involved in DOMS processing. Focusing on the muscular area with the greatest eccentric load (biceps distal fifth), a significant time × group interaction on the pressure pain threshold was observed between preventive SGB and sham (p = 0.034). There was a significant effect on pain at motion (p = 0.048), with post hoc statistical difference at 48 h (preventive SGB Δ1.09 ± 0.82 cm VAS vs. sham Δ2.05 ± 1.51 cm VAS; p = 0.04). DOMS mediated an increase in venous cfDNA -as a potential molecular/inflammatory marker of DOMS- within the first 24 h after eccentric exercise (time effect p = 0.018), with a peak at 20 and 60 min. After 60 min, cfDNA levels were significantly decreased comparing preventive SGB to sham (unpaired t-test p = 0.008). At both times, 20 and 60 min, cfDNA significantly correlated with observed changes in PPT. The 20-min increase was more sensitive, as it tended toward significance at 48 h (r = 0.44; p = 0.1) and predicted the early decrease of PPT following preventive stellate blocks at 24 h (r = 0.53; p = 0.04). Our study reveals the broad impact of the ANS on DOMS and exercise-induced pain. For the first time, we have obtained insights into the sympathetic regulation of pain and inflammation following exercise overload. As this study is of a translational pilot character, further research is encouraged to confirm and specify our observations.
    Keywords vegetative nervous system ; pain therapy ; neuroinflammation ; neurophysiology ; sports medicine ; sympathetic maintained pain ; Physiology ; QP1-981
    Subject code 796
    Language English
    Publishing date 2021-09-01T00:00:00Z
    Publisher Frontiers Media S.A.
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  4. Article ; Online: Dissociated neural processing for decisions in managers and non-managers.

    Svenja Caspers / Stefan Heim / Marc G Lucas / Egon Stephan / Lorenz Fischer / Katrin Amunts / Karl Zilles

    PLoS ONE, Vol 7, Iss 8, p e

    2012  Volume 43537

    Abstract: Functional neuroimaging studies of decision-making so far mainly focused on decisions under uncertainty or negotiation with other persons. Dual process theory assumes that, in such situations, decision making relies on either a rapid intuitive, automated ...

    Abstract Functional neuroimaging studies of decision-making so far mainly focused on decisions under uncertainty or negotiation with other persons. Dual process theory assumes that, in such situations, decision making relies on either a rapid intuitive, automated or a slower rational processing system. However, it still remains elusive how personality factors or professional requirements might modulate the decision process and the underlying neural mechanisms. Since decision making is a key task of managers, we hypothesized that managers, facing higher pressure for frequent and rapid decisions than non-managers, prefer the heuristic, automated decision strategy in contrast to non-managers. Such different strategies may, in turn, rely on different neural systems. We tested managers and non-managers in a functional magnetic resonance imaging study using a forced-choice paradigm on word-pairs. Managers showed subcortical activation in the head of the caudate nucleus, and reduced hemodynamic response within the cortex. In contrast, non-managers revealed the opposite pattern. With the head of the caudate nucleus being an initiating component for process automation, these results supported the initial hypothesis, hinting at automation during decisions in managers. More generally, the findings reveal how different professional requirements might modulate cognitive decision processing.
    Keywords Medicine ; R ; Science ; Q
    Language English
    Publishing date 2012-01-01T00:00:00Z
    Publisher Public Library of Science (PLoS)
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  5. Article ; Online: Moral concepts set decision strategies to abstract values.

    Svenja Caspers / Stefan Heim / Marc G Lucas / Egon Stephan / Lorenz Fischer / Katrin Amunts / Karl Zilles

    PLoS ONE, Vol 6, Iss 4, p e

    2011  Volume 18451

    Abstract: Persons have different value preferences. Neuroimaging studies where value-based decisions in actual conflict situations were investigated suggest an important role of prefrontal and cingulate brain regions. General preferences, however, reflect a ... ...

    Abstract Persons have different value preferences. Neuroimaging studies where value-based decisions in actual conflict situations were investigated suggest an important role of prefrontal and cingulate brain regions. General preferences, however, reflect a superordinate moral concept independent of actual situations as proposed in psychological and socioeconomic research. Here, the specific brain response would be influenced by abstract value systems and moral concepts. The neurobiological mechanisms underlying such responses are largely unknown. Using functional magnetic resonance imaging (fMRI) with a forced-choice paradigm on word pairs representing abstract values, we show that the brain handles such decisions depending on the person's superordinate moral concept. Persons with a predominant collectivistic (altruistic) value system applied a "balancing and weighing" strategy, recruiting brain regions of rostral inferior and intraparietal, and midcingulate and frontal cortex. Conversely, subjects with mainly individualistic (egocentric) value preferences applied a "fight-and-flight" strategy by recruiting the left amygdala. Finally, if subjects experience a value conflict when rejecting an alternative congruent to their own predominant value preference, comparable brain regions are activated as found in actual moral dilemma situations, i.e., midcingulate and dorsolateral prefrontal cortex. Our results demonstrate that superordinate moral concepts influence the strategy and the neural mechanisms in decision processes, independent of actual situations, showing that decisions are based on general neural principles. These findings provide a novel perspective to future sociological and economic research as well as to the analysis of social relations by focusing on abstract value systems as triggers of specific brain responses.
    Keywords Medicine ; R ; Science ; Q
    Subject code 170
    Language English
    Publishing date 2011-04-01T00:00:00Z
    Publisher Public Library of Science (PLoS)
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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