In recent years, ultrasound guided intervention has become a mainstream for treatments of musculoskeletal pain. Compared with traditional fluoroscopy guidance, ultrasound has the advantage of being real-time, zero radiation, and capability of differentiating various soft tissues during intervention. Another advantage of ultrasound is its capability of direct assessment of the neural structures. In particular, the use of ultrasound imaging enables researchers to understand the changes of nerve echo texture after pharmacological applications. Advances in ultrasound technology could potentially further permit the evaluation of intra-neural altered microcirculation and nerve elasticity before and after pharmacological therapies.
There are several regimens commonly used for ultrasound guided injection. The most frequently used one is corticosteroid, with its major effect based on its potential anti-inflammatory effects. Local anaesthetics usually serve as an adjuvant for decreasing pain sensation during injection, but systemic and regional influences such as cardiovascular depression and chondrotoxicity appear to be the main concern of utilizing local anaesthetics. Recently, platelet-rich plasma and high-concentration dextrose have been introduced as treatments for musculoskeletal pain, too. Both the above-mentioned regimens involve less catabolism and in contrast, promote tissue repair and modulate pain responses.
Regenerative medicine has been demonstrated to be effective for pain relief. It is thought that the pharmacology and underlying mechanisms is through the inhibition of transient receptor potential vanilloid receptor-1 (TRPV1), which can trigger nociceptive sensation by evoking an action potential from the peripheral nerve endings, and is susceptible to inflammatory stimuli. Currently, there are great efforts trying to understand the pharmacology between TRPV1 and symptoms of neuropathic pain, and this focus is likely to continue in the near future given its potential. However, although regenerative medicine has demonstrated to have promising outcomes in in-vitro studies, their clinical benefit is still uncertain. The underlying reason may be a result of non-standard preparation of regimens and the different use of in ultrasound guiding techniques. As such, additional clinical pharmacology studies are necessary in order to improve and establish the most effective protocol of ultrasound guided medicine in relieving musculoskeletal and neuropathic pain, and potentially further our knowledge of the underlying neuropharmacology for future drug developments.
In the present Research Topic, we aim to investigate the clinical effectiveness and potential adverse effects of pharmacological application of regimens used for ultrasound guided interventions. We also welcome in-vitro or animal studies exploring the neuropharmacology of the relevant drugs on modulation of pain signal cascades.
 

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John Robert
Managing Editor
Pain Management and Therapy
Mail ID: Painmanagement@emedscholar.com