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Thomas Michels Internal Medicine, Hematology, Radiology, Natural Cure, Cologne (Köln) 50968, GermanyCorrespondence: Thomas MichelsInternal Medicine, Hematology, Radiology, Natural Cure, Pferdmengesstr.8, Cologne (Köln) 50968, GermanyEmail dr.th.michels@web.deAbstract: Peripheral Neuropathic Pain (PNP) as well as the Complex Regional Pain Syndrome (CRPS), also known as “Reflex Sympathetic Dystrophy”, or “Sudeck Dystrophy”, all of them have a poor prognosis. The numerous therapeutic offers are rarely accompanied by convincing success over a long duration of time. Even worse is the prognosis of a fixed dystonia which may develop in the extremities of PNP or CRPS patients. In literature a few cases are reported in which the often unbearable pain of those patients with or without a disabling dystonia disappeared immediately after the injection of local anesthetics (LAs) into the scars of a preceding trauma. This review evaluates publications concerning the neuropathological characteristics of fixed dystonia in PNP/CRPS patients and the electrophysiological processes of scar neuromas. The results of these evaluations support the understanding of the therapeutic successes and their immediate results reported above by the injection of LAs into triggering scars. Therapeutic options are discussed.Keywords: peripheral neuropathic pain, complex regional pain syndrome, fixed dystonia, scar neuroma, local anesthetics, subthreshold membrane potential oscillations

Thomas Michels,1 Seifollah Ahmadi,2 Nicole Graf3 1Outpatient Practice, 50968 Cologne (Koeln), Germany; 2Institute of Physiology II, University of Bonn, 53115 Bonn, Germany; 3Graf Biostatistics, CH-8400 Winterthur, Switzerland Objectives: The efficiency of local anesthetics (LAs) in the treatment of peripheral pain is commonly attributed to their capacity to block the axon conduction of sensory nerves. LAs even in non-blocking concentration suppress oscillations of the resting membrane potential. Spiking in sensory neurons is triggered by subthreshold membrane potential oscillations (SMPOs), which reach threshold and is maintained by depolarizing impulse after oscillations. The suppression of these oscillations abolishes sustained afferent discharge in sensory nerves without blocking the axon conduction. In a retrospective observational study, we examined if LAs in low concentration and very small quantities could reduce peripheral pain in patients.Design: During a period of 2 years, a total of 127 consecutive patients, 43 with cervico-brachial, 12 with intercostal and 72 with lumbo-sciatic pain received an identical treatment, which consisted of LAs applied in 4–8 sessions on average to a fixed set of epidermal, epithelial and periosteal locations. The primary outcome was relief of symptoms measured by verbal analog scales at the end of therapy.Results: At the end of therapy, 53 (41.7%) of all patients (127) had a complete remission (reduction of pain 100%). Twenty-three patients (18.1%) had a partial remission with >90% reduction of pain and 50 patients (39.4%) had a pain reduction of 30%–90%. One patient did not respond.Conclusion: LAs in low concentration and small quantities proved to be highly efficient in the treatment of peripheral pain. An almost complete remission could be obtained in a majority of patients. Given the extent of pain reduction achieved, the method of application seems to be of major importance. Keywords: non-blocking local anesthetics, subthreshold membrane potential oscillations, acute chronic peripheral and neuropathic pain, alpha 1-adrenoceptors, complex regional pain syndrome

Anadromous European smelt (Osmerus eperlanus) is a keystone species in lake and river ecosystems. In the past and present, stock declines in several of its habitats have been reported. The reasons for this are unclear. Experimental research on the early life stages could help to reveal the potential causes. For this purpose, knowledge on artificial propagation and rearing of early life stages is needed. Following from previous work, we show how to scale up and mass rear European smelt using conventional hatchery equipment and present a simplified protocol for first feeding. Smelt eggs, after egg adhesiveness is removed, can be incubated in standard hatchery equipment commonly used in aquaculture. Incubation in McDonald-type jars shows even improved results when settling of floating eggs is prevented. Next to avoiding egg loss this simultaneously reduces labor for daily care. First feeding of larval smelt can be achieved with decapsulated artemia cysts, eliminating the need for the labor-intensive green water production. Using the protocol presented, larvae of different stages can be produced in large quantities allowing further experimental studies.

Objectives: Cervical vertigo (CV) is commonly attributed to a disturbed cervical proprioception and is associated with cervical pain (CP). It is assumed to respond to a treatment that improves CP. In a prospective observational study, we examined whether a treatment originally devised for patients with CP could improve CV also in cases without CP. Design: During a period of 3 years, a total of 238 consecutive patients, 41 patients with CV only, 43 patients with CV and CP, 154 patients with CP only, received the same treatment, which consisted of local anaesthetics applied on average in 8 sessions to a fixed set of epidermal, epithelial, and periosteal locations. Outcome was relief of symptoms measured by a verbal-analogue scale at the end of therapy and on average a year later. Results: At the end of therapy, 58% of patients with CV responded with complete remissions compared to 41% of patients with CP. At follow-up a year later, there were complete remissions in more than 50% in CV as well as in CP. Conclusions: The applied therapy led to complete remissions of long duration in a high percentage of patients with CV even when symptoms of CP were missing. This therapy produced good effects for CP as well. Its neurophysiological basis is discussed and may offer a new approach not only to the treatment of CV and CP but in a general sense also to that of acute, chronic, and neuropathic pain. It needs to be emphasized, however, that this study was not a randomized controled trial and its encouraging results have to be proved by further research. [ABSTRACT FROM AUTHOR]