Pain responses to perineuromal injection of normal saline, gallamine, and lidocaine in humans.
Rat neurons have shown an increase of spontaneously active fibers to systemically administered potassium channel blocking agents such as tetraethylammonium chloride (TEA) and gallamine. Neuroma formation and spontaneous activity have been associated with autotomy in rats and pain in humans. To evaluate the chemosensitivity of human neurons to potassium channel blocking agents, 9 subjects with neuroma pain underwent perineuromal injection in a single-blinded fashion of normal saline, gallamine, and lidocaine. Sodium had no effect on control pain levels, while gallamine significantly increased and lidocaine significantly decreased pain from control levels. Three of 4 patients with accompanying phantom limb pain noted an increase in pain after the injection of gallamine. The data suggest that peripheral input plays a modulating but not solitary role in both neuroma and phantom limb pain. Agents which increase potassium channel permeability or decrease sodium influx would be predicted to decreased perceived pain.
Chabal
Charles
C
Department of Anesthesiology, University of Washington School of Medicine, Veterans Administration Medical Center, 1660 South Columbian Way, Seattle, WA 98108 U.S.A. Department of Neurological Surgery, University of Washington School of Medicine, Veterans Administration Medical Center, 1660 South Columbian Way, Seattle, WA 98108 U.S.A.
Jacobson
Louis
L
Russell
Lisa C
LC
Burchiel
Kim J
KJ
D000328:Adult; D000368:Aged; D005703:Gallamine Triethiodide / Q000627:therapeutic use*; D006801:Humans; D008012:Lidocaine / Q000627:therapeutic use*; D008875:Middle Aged; D009463:Neuroma / Q000150:complications*; D010146:Pain / Q000188:drug therapy*; D010147:Pain Measurement; D010591:Phantom Limb / Q000188:drug therapy; D012965:Sodium Chloride / Q000627:therapeutic use*
D012965:Sodium Chloride; D008012:Lidocaine; D005703:Gallamine Triethiodide