Sciatica Holistic Treatments
Longitudinal section of fiber bundles from the sciatic nerve after staining the myelin sheaths black using osmium tetroxide. Periodically, the myelin sheath shows ring-shaped constrictions called Ranvier nodes (cf. Figs. 260, 261). The axon cylinder is only seemingly exposed at the nodes. Electron microscopy shows that, on the contrary, cytolemma processes from neighboring Schwann cells and a basal membrane (see Fig. 261) cover it. The lightly stained band at the lower edge of the figure is the perineurium (cf. Figs. 263, 264). Detail from a cross-section through the sciatic nerve of a frog. It shows myelinated nerve fibers of different sizes after staining with osmium tetroxide. The myelin sheaths around the axons appear as dark rings (rust-colored stain). Schwann cell nuclei are visible in some places at the outer myelin sheath surface. The axoplasm is lightly stained and shows no structural details in this image. In some areas, there is a glimpse of the endoneurium (stained light...
Intervertebral disk dis- In most cases, sciatica is disk related and is caused by ease degenerative changes of the two lower lumbar motion Sciatic nerve damage due to injection Inflammatory or degenerative diseases of the sacroiliac joints can cause symptoms similar to the proximal pain area of sciatica
As many as 85 of adults experience lower back pain that interferes with their work or recreational activity and up to 25 of the people between the ages of 30 to 50 years report low back symptoms when surveyed 1 . Of all lower back patients, 90 recover within six weeks irrespective of the type of treatment received 2 . The remaining 10 who continue to have problems after three months or longer account for 80 of disability costs 1 . Webster and Snook 3 estimated that lower back pain in 1989 incurred at least 11.4 billion in direct workers' compensation costs. Frymoyer and Cats-Baril 4 estimated that direct medical costs of back pain in the U.S. for 1990 exceeded 24 billion, and when indirect costs predominately associated with workers' compensation claims were added, the total cost was estimated to range from 50 billion to 100 billion. One U.S. workers' compensation insurance company incurred costs for lower back pain of about 1 billion per year, whereas the total cost for carpal tunnel...
The brain is also a major site of apolipoprotein E (apoE) mRNA expression in humans, marmosets, rats and mice.62 Early data from animal lesion paradigms such as sciatic nerve crush 63,64 and entorhinal cortex lesioning 65,66 suggested that apoE plays a role in the coordinated storage and redistribution of cholesterol and phospholipids among cells within the remodeling area. Apolipoprotein E is now believed to play an important role not only in reactive synaptogenesis, by delivering lipids to remodeling and sprouting neurons in response to tissue injury, but also in physiological ongoing synaptic plasticity and maintenance of neuronal integrity, as well as in cholinergic activity. 67-69
Researchers at the University of Utah have conducted experiments addressing this last issue. They have developed a unique electrode array architecture that was designed to provide highly selective electrical access to a number of the nerve fibers in the sciatic nerve.53 This device, the Utah Slanted Electrode Array (USEA), is shown in Figure 11.7, and its access to the fibers in the nerve is depicted in Figure 11.8. It is built from silicon and contains 100 electrodes designed to penetrate the epineurium that surrounds the nerve and the perineuria that surround the individual fascicles within the nerve. The length of each electrode varies along the length of the array, with 0.5-mm-long electrodes on one side of the array, and 1.5-mm-long electrodes on the opposite side of the array. Each electrode is electrically isolated from its neighboring electrodes with a moat of glass at its base, and each electrode has a lead wire connected to a bond pad at its base that is The Utah researchers...
At the time of birth the CNS contains large numbers of microglial cells, most of which are of the intermediate type with stout cellular processes (Figures 5.1 to 5.3). These young microglia, like their adult ramified counterparts, are exquisitely sensitive to neuronal death and are quickly activated following CNS injury. In fact, most microglia in the developing CNS are in an activated state as judged by their morphology and phagocytic activity. Intermediate microglia are active in the phagocytic removal of apoptotic cells throughout the developing CNS (Figure 5.3). When in addition to naturally occurring cell death there is experimentally induced neurodegeneration, such as after peripheral nerve lesions, activation of immature microglia involves changes in cell immunophenotype. These phenotypic changes, which reflect altered expression of cell surface receptors, are similar to those seen during activation of adult microglia after a CNS lesion. When activated by neonatal sciatic nerve...
Differentiation and instructively promotes glial differentiation, in cultures of postmigratory neural crest stem cells isolated from fetal rat sciatic nerve (Morrison et al., 2000b Kubu et al., 2002). While Notch activation also instructively promotes the glial differentiation of migrating neural crest stem cells, it is less efficient at inhibiting neuronal differentiation than in postmigratory cells, suggesting that glial promotion and neuronal inhibition are independent effects (Kubu et al., 2002).
In the rat, postmigratory neural crest stem cells from fetal sciatic nerves do not differentiate into neurons as readily as migrating neural crest stem cells, as shown by transplantations to chick neural crest cell migratory pathways (White and Anderson, 1999 White et al., 2001). These fetal nerve neural crest stem cells express significantly higher levels of Notch1, and lower levels of the Notch antagonist Numb, than migrating neural crest stem cells (Kubu et al., 2002). Postmigratory cells on the sciatic nerve are therefore more sensitive to Notch activation than migrating cells and hence more likely to differentiate into glia (Kubu et al., 2002). The changes in Notch1 and Numb expression levels, and
FIGURE 9.15 Increased muscle activity accelerates synapse elimination. Most rat soleus muscles are polyneuronally innervated between postnatal days 8-10 (green line). When a stimulating electrode was implanted in the leg to activate the sciatic nerve and muscle from postnatal days 6-8, there was a severe decline in the number of polyneuronally innervated muscle cells (red circles). (Adapted from O'Brien et al., 1978) FIGURE 9.15 Increased muscle activity accelerates synapse elimination. Most rat soleus muscles are polyneuronally innervated between postnatal days 8-10 (green line). When a stimulating electrode was implanted in the leg to activate the sciatic nerve and muscle from postnatal days 6-8, there was a severe decline in the number of polyneuronally innervated muscle cells (red circles). (Adapted from O'Brien et al., 1978)
The differentiation of parasympathetic vs sympathetic autonomic neurons may be determined by local concentrations of BMPs at different neural crest target sites, as well as, perhaps, differential sensitivities of responding neural crest cells to BMPs (White et al., 2001). Postmigratory rat neural crest stem cells, isolated from fetal sciatic nerve, are more likely to differentiate as cholinergic parasympathetic neurons than as catecholaminer-gic sympathetic neurons when back-grafted into chick neural crest migratory pathways (White et al., 2001). After such grafts, they form cholinergic neurons in both sympathetic ganglia and parasympathetic ganglia, such as the pelvic plexus (White et al., 2001). In culture, they respond to BMP2 by differentiating as both cholinergic and noradrenergic autonomic neurons. However, they are significantly less sensitive to the neuronal differentiation-inducing activity of BMP2 than are migrating neural crest stem cells (section Differences in the...
Also known as Dyer's greenwood, Dyer's weed or woad-waxen, it is a small, tufted shrub bearing racemes of yellow flowers. Cattle eating this wild plant add bitterness to their milk and to the cheese and butter made from it. It is found in England, rarely in Scotland, is wild throughout Europe, and has been established in the eastern part of the United States. It has been purposely cultivated in the United States due to its profusion of yellow flowers. It has been used for several ailments including dropsy, gout, rheumatism, sciatica, and even rabies. During the 14th century it was used to make an ointment called Unguentum geneste, goud for alle could goutes , et cetera. The seed was also reported to be used in the plaster to heal broken limbs.
As discussed in the section on Notch Activation Leads to Gliogenesis by Neural Crest Stem Cells, even transient activation of Notch signaling inhibits neuronal differentiation and instructively promotes glial differentiation, in cultures of postmigratory neural crest stem cells isolated from fetal rat sciatic nerve (Morrison et al., 2000b). This action of Notch is dominant over that of BMP2, blocking neurogenesis at a point upstream of Mashl induction (Morrison et al., 2000b). It is likely that a similar mechanism of Notch activation acts within autonomic ganglia to promote satellite cell differentiation in the presence of BMP2. One model suggested by these results is that differentiating autonomic neurons express Notch ligands these then activate Notch signaling in neighboring non-neuronal cells, which are then able to differentiate as glia (Morrison et al., 2000b). Other gliogenesis-promoting factors, such as NRG1 type II, may also act in concert with, or...
Wallerian Degeneration of Nerve Fibers in the CNS Is Accompanied by Increased Expression of Clusterin in Astrocytes and
In situ hybridization with a (32S)-labeled oligonucleotide probe for clusterin mRNA in the L4 spinal cord segment one week following unilateral transection of the sciatic nerve in the adult rat. Note the increased labeling over the ventral and dorsal horns reflecting upregulation in ventral horn motoneurons as well as in astrocytes around the axotomized motoneurons and in the projection territory of the peripherally axotomized primary sensory neurons (right). Bar 500 im. Fig. 8.2. In situ hybridization with a (32S)-labeled oligonucleotide probe for clusterin mRNA in the L4 spinal cord segment one week following unilateral transection of the sciatic nerve in the adult rat. Note the increased labeling over the ventral and dorsal horns reflecting upregulation in ventral horn motoneurons as well as in astrocytes around the axotomized motoneurons and in the projection territory of the peripherally axotomized primary sensory neurons (right). Bar 500 im.
Standard cell culture methods are used for all cell types. Usually, we passage the cells in multiwell culture dishes on square no. 1 coverslips (Clay Adams, USA) at a density of 1 - 2 x 105 cells cm2, which allows us to select individual cells for the coupling procedure. The optimal experimental time after cell passage depends on the cell type. For almost all cell lines we have tested, for example, HeLa, N2A, and RIN, transfected with different connexins, we found it to be optimal to perform the experiments on the second and third days after passage. The experiments on freshly isolated myocytes from neonatal rat heart, however, are conducted on the same day, 6-8 h after cell passage. After 2 d in culture, myocytes are so strongly adherent to the coverslips that it was difficult to separate them without damage. Other cells, such as freshly isolated fibroblast or Schwann cells from sciatic nerve of newborn rats, change they morphology with time, becoming very flat or projecting...
Because adult sensory neurons respond to NGF with enhanced neurite outgrowth in culture186 and regeneration of their peripheral projections in vivo,187 188 the effect of NGF on sensory regeneration in the adult rat spinal cord has been investigated. Intrathecal infusion of NGF can enhance regeneration of sensory fibers from the spinal cord into nerve grafts.189 NGF-coated nitrocellulose bridges can guide and promote ingrowth of reimplanted dorsal root fibers into fetal spinal cord transplants and into the host spinal cord tissue itself over very short distances.190-192 Intraspinal grafts of NGF-producing193 194 or NT-3-producing fibroblasts194 195 cause a robust ingrowth of sensory axons into the grafts. The limited extent of ingrowth back into the spinal cord in such studies is most likely caused by insufficient levels of neu-rotrophin in the spinal cord and or the tropic properties of NGF that may have impeded outgrowth away from the grafts. In the septohippocampal system, NGF...
Lakhbir Singh and Mark Field performed initial studies of gabapentin for use as an analgesic in animal models in 1992-1993 at the Parke-Davis Cambridge (UK) Research Centre. They found that gabapentin was active in several rat models of antihyperalgesic action (formalin test, carrageenan test),37,38 although at rather high dosages. Gary Bennett obtained a sample of gabapentin in 1993, and tested it in his model of neuropathic pain from sciatic nerve ligation in rats.39 These results from animal models were presented by Bennett at a national meeting in 1994, and at about the same time, the first case reports of gabapentin use for neuropathic pain appeared in the literature.40,41 Subsequently, a large number of investigators found gabapentin to be active in animal models of pain states14,38,42-61 and also in several clinical studies.62-65
FGF-2, the most promising candidate of the FGF family, occurs in different isoforms. However, all of the effects of FGF-2 reported so far have been achieved by application of the 18-kDa isoform. It is therefore not clear whether all isoforms display similar activities or whether they differentially regulate cell metabolism. A correlation between expression of a certain isoform and cell morphology has been demonstrated, for example, in cardiac myocytes.69 In the peripheral nervous system, FGF-2 isoforms were found to be differentially regulated in spinal ganglia and at the lesion site after sciatic nerve injury.167 This differential regulation might be evidence for an isoform-specific function. Analysis of the FGF-2 isoform effects may therefore lead to therapeutic tools with increased efficiency and specificity and, possibly, less side effects. The same is true for the recently identified FHFs, which are also present in the nervous system.
The recognition of acupuncture by Western medicine is not entirely new. In the late 1800s, Sir William Osler, one of the most honored and respected physicians and medical educators, wrote a textbook of medicine in which he recommended acupuncture for low back pain and sciatica. In 1901, Gray's Anatomy, a classic medical text, also referred to acupuncture as a treatment for sciatica.
Individuals who report a history of numerous allergies or previous transfusions should be monitored more carefully since they are at higher risk for reaction. A history of cardiovascular disease should be noted because those patients need to be monitored more carefully for fluid overload. Note also if a patient has a history of Raynaud's disease or a cold agglutinin problem, because, before being administered and with physician approval, blood needs to be warmed. Once the transfusion is in process, the patient may report any of the following signs of transfusion reaction heat or pain at the site of transfusion, fever, chills, chest tightness, lower back pain, abdominal pain, nausea, difficulty breathing, itching, and a feeling of impending doom.
Diabetic rats show reduction in sensory motor conduction velocities and nerve action potentials and reduction in peripheral nerve blood flow and all these abnormalities can be prevented by pretreatment with anti-AGE agents such as aminoguanidine (114,115). Pentosidine content was increased in cytoskeletal proteins of the sciatic nerve of streptozotocin induced diabetic rats and decreased after islet transplantation (111).
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