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Central Nervous System thru Peripheral Nerves Maintains Joint Inflammation.

Recent studies have identified a major contribution of the nervous system to inflammation and to inflammatory disease. In particular, substances released from the peripheral nerve terminals have been implicated in several of the major components of acute inflammation as well as in the regulation of tissue injury in an inflammatory disease model, experimental arthritis. (Basbaum AI et al. The contribution of the nervous system to inflammation and inflammatory disease. Can J Physiol Pharmacol. 1991 May;69(5):647-51). For example, stroke patients whose nerves on one side of their bodies have been damaged tend not to develop arthritis, or only to develop mild cases, on that side. This is true not just for osteoarthritis, the wear-and-tear form that afflicts older people, but also for gout and rheumatoid arthritis, which are thought of as immune disorders that normally afflict both sides equally.

Study by Levine JD et al showed that large- and small-diameter afferents, sympathetic efferents, and CNS circuits that modulate those fiber systems all influence the severity of joint arthritis. (Contribution of sensory afferents and sympathetic efferents to joint injury in experimental arthritis. J Neurosci. 1986 Dec;6(12):3423-9).

Study by Sluka KA et al also demonstrated that the central terminals of primary afferents are important in the development of acute joint inflammation since dorsal rhizotomy attenuated the inflammatory response in the knee joint. (Joint inflammation is reduced by dorsal rhizotomy and not by sympathectomy or spinal cord transection. Ann Rheum Dis. 1994 May;53(5):309-14).

The recent studies suggest that the nervous system may be just as important as the immune system in causing arthritis damage. Peripheral and spinal neuronal mechanisms involved in the processing of musculoskeletal pain. There is a complicated neuronal network in the periphery and the spinal cord for the processing of painful information. Injury to a joint (inflammation) or muscle (inflammation or ischemia) results in sensitization of peripheral pain receptors. There is then an increased transmission to and increased release of neurotransmitters in the dorsal horn of the spinal cord. Dorsal horn neurons sensitized by the peripheral injury demonstrate increased background activity, increased receptive field size, and increased responses to peripherally applied stimuli. In addition to processing nociceptive information following joint or muscle injury, the spinal cord controls peripheral joint inflammation. Production of dorsal root reflexes, antidromic action potentials, would be expected to result in the release of inflammatory neuropeptides [substance P and calcitonin gene-related peptide (CGRP)] from the terminals of primary afferents at the site of injury. The release of substance P and CGRP would potentiate the inflammatory response in the periphery.

Recently number of studies did confirm effectiveness of radiofrequency denervation for treatment of arthritic inflammation and pain:

Shoulder joint arthritis: 1. Pulsed radiofrequency lesioning of the suprascapular nerve for chronic shoulder pain: a preliminary report. Liliang PC et al. Pain Med. 2009 Jan;10(1):70-5. 2. Pulsed radiofrequency applied to the suprascapular nerve in painful cuff tear arthropathy. Kane TP et al. J Shoulder Elbow Surg. 2008 May-Jun;17(3):436-40.. 3. Pulsed mode radiofrequency lesioning of the suprascapular nerve for the treatment of chronic shoulder pain. Shah RV, Racz GB. Pain Physician. 2003 Oct;6(4):503-6. 4. Efficacy of pulsed mode radiofrequency lesioning of the suprascapular nerve in chronic shoulder pain secondary to rotator cuff rupture. Gurbet A et al. Agri. 2005 Jul;17(3):48-52.

Hip joint arthritis: 1. Radiological anatomy of the obturator nerve and its articular branches: basis to develop a method of radiofrequency denervation for hip joint pain. Locher S et al. Pain Med. 2008 Apr;9(3):291-8. 2. Pulsed radiofrequency treatment of articular branches of the obturator and femoral nerves for management of hip joint pain. Wu H, Groner J. Pain Pract. 2007 Dec;7(4):341-4. Epub 2007 Nov 6. 3. Radiofrequency treatment of peripheral nerves. Rohof OJ. Pain Pract. 2002 Sep;2(3):257-60. 4. Percutaneous radiofrequency lesioning of sensory branches of the obturator and femoral nerves for the treatment of non-operable hip pain. Malik A et al. Pain Physician. 2003 Oct;6(4):499-502.

Knee joint arthritis: 1. Pulsed Radiofrequency Lesioning of the Saphenous Nerve in Degenerative Osteoarthritis of Knee. Lee SJ, et al. J Korean Pain Soc. 2003 Dec;16(2):212-216.