Odontalgia Atípica (OA) é uma condição dolorosa orofacial crônica de intensidade moderada a severa, que ocorre nas estruturas dentoalveolares e na mucosa oral. É considerada de difícil diagnóstico por estar associada com a ausência de alterações clínicas e radiográficas perceptíveis. Seus aspectos patofisiológicos sensoriais e de manutenção e perpetuação da dor ainda são mal compreendidos. Os objetivos deste estudo foram: (1) avaliar as alterações somatossensoriais em pacientes com OA através dos testes sensoriais quantitativos (QST); (2) ampliar o conhecimento disponível sobre os mecanismos de modulação da dor através do teste de controle de modulação da dor (CPM); e (3) avaliar as condições psicológicas como ansiedade e depressão, qualidade do sono e qualidade de vida através de questionários auto-aplicáveis. Um total de 50 indivíduos foram incluídos, sendo 25 sujeitos do grupo sintomático com OA (19 mulheres, 58,25 +- 12,17 anos de idade) e 25 sujeitos saudáveis do grupo controle (19 mulheres, 58,92 +- 7,39 anos)(p>0.05). Os QSTs englobaram os testes de Limiar de Detecção Mecânica (MDT), Limiar de Sensibilidade Dolorosa Mecânica (PDT), Teste Mecânico de Alodinia com cotonete (DMA1) e escova dental (DMA2), Testes de Detecção Dolorosa do tipo quente (HPD) e gelado (CPD) e o Teste de Somação Temporal (WUR). O controle de modulação da dor foi feito através do teste CPM e as avaliações psicológicas através do Inventário de Ansiedade e Depressão de Beck, o Índice de Qualidade do Sono de Pittsburg e o Questionário de Qualidade de Vida SF-36. Os QSTs foram repetidos após a aplicação de uma pomada anestésica de Benzocaína 2%. A análise estatística foi feita através dos testes t pareado, teste t e o teste não paramétrico de Mann-Whitney, considerando-se um nível de significância de 5%. Os resultados indicaram que sujeitos com OA apresentam ganho sensorial por meio de estímulos térmicos do tipo quente (HPD) e gelado (CPD) e estímulos mecânicos dinâmicos (DMA1, DMA2 e WUR), e perda sensorial à estímulos mecânicos (MDT, PDT). Ainda, o teste CPM reduziu a intensidade da dor significativamente somente para o grupo controle. A aplicação tópica de anestesia indicou uma redução significativa na intensidade da dor nos indivíduos afetados. Além disso, sujeitos com OA apresentaram sintomas de maior depressão e ansiedade, qualidade do sono ruim e baixa qualidade de vida comparados à pacientes saudáveis. Este estudo enfatizou que alterações somatossensoriais significativas são encontradas em sujeitos com OA, onde envolve uma participação de processos periféricos de sensitização e condução da dor, associado à fenômenos de alodínia e hiperalgesia, o que sugere alterações em nível de sensitização central. O sistema modulátorio de dor mostra-se deficiente e as condições psicológicas estão afetadas em sujeitos com OA. / Atypical Odontalgia (AO) is a chronic orofacial painful condition, which occurs in dentoalveolar structures and oral mucosa. AO is difficult to diagnose because it is associated with the absence of any clinical and radiographic alterations. Repetitive dental procedures are made, with the aim to relief pain. Sensory pathophysiological aspects and pain maintenance and perpetuation are still poorly understood. The aim of this study were: (1) evaluate somatosensory abnormalities in AO patients through quantitative sensory testing (QST), (2) evaluate mechanisms of pain modulation through the controlled pain modulation test (CPM), and (3) assess the psychological features such as anxiety, depression, sleep quality and quality of life through selfreported questionnaires. A total of 50 subjects were included, consisting of 25 subjects with symptomatic AO (19 women, 58.25 +- 12.17 years old) and 25 subjects in the control group (19 women, 58.92 +- 7.39 years old)(p>0.05). QST encompassed Mechanical Detection Threshold (MDT), Pain Detection Threshold (PDT), Dynamical Mechanical Allodynia with a cotton swab (DMA1) and with a toothbrush (DMA2), Cold Pain Detection (CPD), Heat Pain Detection (HPD) and Wind-up Ratio (WUR). Pain modulation was performed by CPM and psychological evaluations through Anxiety Inventory and Beck Depression Index, the Pittsburgh Sleep Quality and Quality of Life Questionnaire SF-36. QSTs were repeated after the administration of an anesthetic cream (2% Benzocaine). Statistical analysis was performed using the \"t\" test, paired t test and nonparametric Mann-Whitney test considering a significance level of 5%. Results indicated that AO subjects showed sensory gain through heat (HPD) and cold (CPD) stimuli and dynamic mechanical stimuli (DMA1, DMA2 and WUR), and sensory loss to mechanical stimuli (MDT, PDT). Moreover, CPM reduced pain intensity significantly only in the control group. A topical anesthesia showed a significant reduction in pain intensity in affected subjects. Furthermore, subjects with AO had symptoms of depression and anxiety, poor sleep quality and poor quality of life compared to healthy individuals. This study emphasized that somatosensory abnormalities are found in subjects with AO, which involves participation of peripheral sensitization associated with allodynia and hyperalgesia, suggesting central sensitization abnormalities. Pain modulation system proves deficient and psychological conditions are affected in subjects with AO.

A dor associada ao câncer pode ser causada não somente pelos efeitos diretos ou indiretos da patologia primária, mas também pelo tratamento quimioterápico. A Cisplatina é um dos medicamentos anti-neoplásicos mais efetivos e mais comumente usados no tratamento de tumores sólidos. Entretanto, um de seus principais efeitos colaterais é a neurotoxicidade periférica. Os mecanismos celulares e moleculares da dor crônica induzida por quimioterápico são ainda bastante obscuros. Investigamos o papel da proteína quinase dependente de RNA (PKR) nos diferentes mecanismos neurobiológicos associados à dor crônica induzida pelo quimioterápico Cisplatina. O presente estudo avaliou: (1) O desenvolvimento de alodínia mecânica e hipernocicepção térmica em camundongos PKR-/- e PKR+/+ submetidos à administração do quimioterápico Cisplatina; (2) O estado de fosforilação das MAPKs (Erk1,2, p38 e JNK/SAP) e o fator de transcrição STAT-3 nas células do gânglio da raiz dorsal de animais tratados com Cisplatina; (3) Alterações na resistência e força muscular dos camundongos PKR-/- e PKR+/+ submetidos a administração do quimioterápico Cisplatina; (4) A proteólise muscular em músculos EDL (glicolíticos) e soleus (oxidativos) de camundongos PKR-/- e PKR+/+ após tratamento com Cisplatina (5) A síntese proteica através de Western Blot das proteínas Akt, FoxO 1 e FoxO 4, S6k1 e a S6 em células C2C12 analisando temporalmente o efeito da Cisplatina (6h, 12h e 24h); (6) O estresse oxidativo mitocondrial em células do gânglio da raiz dorsal e do músculo Soleus de camundongos PKR-/- e PKR+/+ após tratamento com Cisplatina. Os resultados obtidos foram: (1) Que com o tratamento com cisplatina produziu hipernocicepção térmica e alodínia mecânica nos animais PKR+/+; (2) A reduz da fosforilação do p38 não justifica o quadro de hipernocicepção e a hipernocicepção pode ocorrer a partir do aumento da fosforilação de STAT 3; (3) Animais que não tem a PKR são menos vulneráveis à ação deletéria da cisplatina sobre o músculo pois todos os testes comportamentais para atividade motora; (4) Não houve diferença na proteólise total mas sim na síntese proteica em animais PKR tratados com cisplatina; (5) Há alteração na via Akt quando analisa temporalmente a ação da cisplatina; (6) animais PKR -/- apresentaram índices mais altos da respiração mitocondrial comparados aos PKR +/+. Este estudo combinou métodos de biologia celular e molecular com paradigmas comportamentais a fim de investigar os possíveis mecanismos de ação da PKR no desenvolvimento de hipersensibilidade sensorial após o tratamento com quimioterápico. Os resultados deste trabalho devem evidenciar novos mecanismos neurobiológicos que contribuam para o entendimento da fisiopatologia da dor crônica de origem neurotóxica e apontar novas estratégias terapêuticas para o tratamento da dor crônica causada por quimioterapia / Pain associated with cancer can be caused by only direct or indirect products of the primary pathology, but also by chemotherapeutic treatment. Cisplatin is one of the most effective and most common anti-neoplastic drugs without the treatment of solid tumors. However, one of its major side effects is peripheral neurotoxicity. The cellular and molecular mechanisms of chronic pain induced by chemotherapy are still rather obscure. Investigators of role of RNA-dependent protein kinase (PKR) in the different neurobiological mechanisms associated with chronic pain induced by the chemotherapeutic Cisplatin. The present study evaluated: (1) the development of mechanical allodynia and thermal hypernociception in mice PKR - / - and PKR + / + submitted to chemotherapy Cisplatin; (2) The state of phosphorylation of the MAPKs (Erk1,2, p38 and JNK / SAP) and the transcription factor STAT-3 in the cells dorsal root ganglion of Cisplatin-treated animals; (3) Changes in muscle strength and strength of mice PKR - / - and PKR + / + submitted to the administration of the chemotherapeutic Cisplatin; (4) Muscle protein in EDL (glycolytic) and soleus (oxidative) muscles of mice PKR - / - and PKR + / + after treatment with Cisplatin (5) Western Blot Synthesis Protein of Akt, FoxO 1 and FoxO 4 S6k1 proteins and S6 in C2C12 cells by temporarily analyzing the effect of Cisplatin (6h, 12h and 24h); (6) Mitochondrial oxidative stress in dorsal root ganglion and Soleil muscle cells of PKR - / - and PKR + / + mice after treatment with Cisplatin. The results obtained were: (1) That with the treatment with cisplatin produced thermal hypernociception and mechanical allodynia in the animals PKR + / +; (2) The reduced phosphorylation of p38 does not justify the hyperencouragement and hypernociception can occur from increased STAT 3 phosphorylation; (3) Animals that do not have a PKR are less vulnerable to the deleterious action of cisplatin on muscle for all behavioral tests for motor activities; (4) There was no difference in total proteolysis but in protein synthesis in PKR animals treated with cisplatin; (5) There is alteration in the Akt pathway when the action of cisplatin is temporarily analyzed; (6) Animals PKR - / - had higher mitochondrial respiration rates compared to PKR + / +. This study combined methods of cellular and molecular biology with behavioral paradigms to investigate the possible mechanisms of action of PKR in the development of sensory hypersensitivity after treatment with chemotherapy. The results of this program are mandatory, which are responsible for the development of medicines for health and human health

La douleur neuropathique est un syndrome secondaire à une maladie ou à une lésion affectant le système nerveux somatosensoriel. Les causes biologiques de ces comorbidités ne sont pas clairement établies. En utilisant un modèle murin de douleur neuropathique, nous avons cherché à amplifier l'inhibition nerveuse médiée par les récepteurs GABAA afin de tenter de réduire les symptômes douloureux neuropathiques et les troubles émotionnels associés. Pour cela nous avons utilisé l’étifoxine, un anxiolytique non benzodiazépinique qui possède une action originale sur les récepteurs GABAA mais, surtout, semble avoir des effets secondaires limités comparativement à d'autres molécules comme les benzodiazépines par exemple. Son effet passe par la potentialisation directe du récepteur GABAA (site modulateur situé sur les sous-unités β2 et β3) mais aussi par une action indirecte : la stimulation de la production de neurostéroïdes 3α-réduits capables de potentialiser la fonction des récepteurs GABAA. Quelques rares études ont montré que les neurostéroïdes endogènes, surtout ceux réduits en position 3α comme l'allopregnanolone (THP, allotétrahydroprogestérone) ou le THDOC (tétrahydrodéoxycorticostérone), pouvaient réduire les symptômes douloureux. Les effets obtenus dans ces études sont similaires à ceux issus d’injections exogènes des mêmes composés. / Neuropathic pain is associated with significant co-morbidity, including anxiety and depression, which impact considerably on the overall patient experience. Several lines of evidence suggest that anxiolytics may be of interest to alleviate pain symptoms and the associated negative emotions in chronic pain states. Among them, the non-benzodiazepine anxiolytic etifoxine (EFX: stresam™) has an interesting pharmacological profile. In patients, it has a weak sedative action, with limited functional tolerance and dependence, and without cognitive declines. In this study, we aim at analyzing the preclinical therapeutic potential of etifoxine on the anxiodepressive consequences of neuropathic pain.

Bakgrund Ett flertal studier beskriver de svårigheter som är förenade med behandling av neuropatisk smärta. Få studier beskriver långvarig neuropatisk smärta ur patientens självupplevda perspektiv och strategier för att klara av vardagen. Mer kunskap behövs ur ett patientperspektiv avseende upplevelser av att leva med neuropatisk smärta. Syftet med föreliggande studie var att beskriva patienters upplevelser av att leva med neuropatisk smärta. Metod Studien är empirisk och deskriptiv med en kvalitativ ansats. Elva intervjuer genomfördes med män och kvinnor mellan 18- 67 år, som hade haft neuropatisk smärta i minst tre månader. Intervjuerna transkriberades och analyserades med hjälp av innehållsanalys. Resultat Neuropatisk smärta medför en rad olika konsekvenser. Sömnsvårigheter, trötthet dagtid och svårigheter att utföra vardagliga aktiviteter beskrevs. Även yrkesliv och det sociala livet påverkades av smärtan. Flera olika strategier för att hantera smärtan beskrevs. Vissa strategier användes medvetet men informanterna verkade också använda sig av strategier utan att själva vara medvetna om det. Vikten av att bli bemött med respekt och tillit framhölls och informanterna menade att de inte hade blivit bemötta på ett förtroendeingivande sätt förrän de kom i kontakt med en smärtklinik. Slutsats och klinisk betydelse Neuropatisk smärta påverkar både yrkesliv, vardagliga aktiviteter och det sociala livet. Olika strategier användes för att klara av smärtan och olika aktiviteter men medvetenheten om strategierna verkade variera. Vidare studier behövs för att klargöra dessa skillnader. / Background There are many studies about the difficulties associated with treating neuropathic pain, and some about pain as an ongoing process and strategies to manage the everyday life. However, more knowledge is needed about experiences of living with neuropathic pain from the patients´ point of view. Aim To describe experiences of living with neuropathic pain. Method Empiric and descriptive. Interviews were conducted with eleven participants, 18- 67 years old, who had had a period of more than three months of neuropathic pain. Participants were asked to describe their experiences of living with neuropathic pain. Transcribed interviews were analysed with content analysis. Findings Living with neuropathic pain brings a lot of consequences. Sleeping difficulties, daytime tiredness and difficulties in performing everyday life activities were described. Working life was also affected by the pain. Many different strategies were described to handle these consequences. Some strategies were consciously used but the participants also seemed to use strategies without being aware of it. The great importance of being treated with trust and respect was emphasized and some participants pointed out that they hadn´t been met with respect and in a way that creates trust until they got in contact with a pain clinic. Conclusion and relevance for clinical practice Living with neuropathic pain affects work, every day´s activities and social life. Strategies were used to manage the pain and activities, but the awareness of it varied. For further directions more studies are needed to clarify the differences of awareness.

La douleur chronique est une pathologie invalidante de longue durée notamment caractériséepar trois symptômes : l’allodynie (un stimulus non douloureux est perçu comme douloureux),l’hyperalgésie (un stimulus douloureux est perçu comme encore plus douloureux) et desdouleurs ambulatoires. Quand cette douleur est due à une lésion ou une dysfonction du systèmenerveux on parle de douleur neuropathique. Chez les patients et les modèles animaux dedouleurs neuropathiques, les études ont montré que les neurones thalamiques étaienthyperexcitables. Les cellules gliales, astrocytes et microglies, sont des partenaires synaptiquesimpliqués dans la transmission et la plasticité synaptique et pourraient être impliqués dans cephénomène. En effet, ces cellules peuvent modifier leur phénotype lorsque le système nerveuxest affecté, elles sont réactives : leur morphologie est hypertrophiée, l’expression d’ARNm et deprotéines comme iba-1 (ionized binding-adaptor molecule 1) et CD11b/c (cluster ofdifferentiation 11b/c) pour les cellules microgliales et GFAP (glial fibrillary acidic protein) etS100β (S100 calcium binding protein β) pour les cellules astrocytaires est augmentée. Ellespeuvent également libérer des molécules pro-inflammatoires. Tout ceci pourrait générer ouamplifier l’hyperexcitabilité des neurones présents dans le thalamus.Mon travail de thèse a consisté en l’étude des astrocytes et de la microglie thalamique dans lemodèle de douleurs neuropathiques de ligature des nerfs spinaux L5-L6 du nerf sciatique (spinalnerve ligation, SNL). Les symptômes d’allodynie et d’hyperalgésie mécaniques ont étécaractérisés par le test des filaments de von Frey et les douleurs ambulatoires par le test dedistribution pondéral dynamique. L’expression des ARNm de marqueurs gliaux a été étudiée parune approche de qRT-PCR sur des prélèvements thalamiques et sur des noyaux thalamiquesobtenus par microdissection au laser. L’expression neurochimique des marqueurs iba-1,CD11b/c, Cathepsine S, GFAP et S100β a été étudié par immunohistofluorescence en quantifiantle nombre de cellules immunopositives et la surface occupée par les marqueurs. Toutes cesexpériences ont été réalisées à J14 et J28 après la chirurgie.A J14, les animaux SNL développent des symptômes d’allodynie et d’hyperalgésie mécaniqueainsi que des douleurs ambulatoires. Chez ces animaux, les cellules microgliales thalamiquesprésentent des signes de réactivité avec l’augmentation de l’expression des ARNm desmarqueurs CTSS et CX3CR1, le récepteur de la fractalkine, marqueurs connus pour leursimplications dans l’hyperexcitabilité neuronale spinale en conditions de douleursneuropathiques. De plus, l’expression neurochimique des marqueurs gliaux étudiés est diminuéece qui se traduit notamment par une diminution du nombre de cellules immunopositives pources marqueurs chez les animaux SNL. A J28, les symptômes douloureux sont maintenus. De plus,la réactivité microgliale décelée à J14 par qRT-PCR est toujours présente avec l’augmentation del’expression de l’ARNm codant pour la fractalkine (CX3CL1), partenaire de la voieCTSS/CX3CR1/CX3CL1. La diminution de l’expression neurochimique thalamique desmarqueurs gliaux chez les animaux SNL était transitoire et n’est plus présente à J28. Enrevanche, des signes de réactivité astrocytaire thalamique ont été mis en évidence chez lesanimaux SNL.Ainsi, ce travail dévoile une ambivalence au niveau des altérations de la glie thalamique dans cemodèle SNL: une diminution précoce de l’expression des marqueurs gliaux thalamiques suivied’une réactivité astrocytaire plus tardive concomitante à des signes de réactivité microgliale. Denombreuses expériences sont encore nécessaires pour appréhender l’impact de cetteambivalence gliale thalamique inédite dans un contexte de douleur neuropathique. / Chronic pain is an incapacitating and long lasting pathology mainly characterized by threesymptoms: allodynia (a non painful stimulus is perceived as painful), hyperalgesia (a painfulstimulus is perceived as more painful) and ambulatory pains. When chronic pain is due to alesion or dysfunction of nervous system it is called neuropathic pain. In both patients and animalmodels of neuropathic pain, researchers found that thalamic neurons are hyperexcitable. Glialcells, astrocytes and microglia, are strong synaptic partners involved in synaptic transmissionand plasticity and therefore could be involved in this phenomenon. Indeed, these cells canmodify their phenotype when nervous system is damaged. They become reactive: theirmorphology is hypertrophied, mRNA and protein expression of iba-1 (ionized binding-adaptormolecule 1) and CD11b/c (cluster of differentiation 11b/c) for microglia and GFAP (glialfibrillary acidic protein) and S100β (S100 calcium binding protein β) for astrocytes is increased.They could also release pro-inflammatory molecules. All of these could contribute to generate oramplify the thalamic neuronal hyperexcitability.In my PhD work I studied thalamic astrocytes and microglia in a rat neuropathic pain model ofL5-L6 spinal nerves ligation (SNL). Mechanical allodynia and hyperalgesia were characterizedwith von Frey filament test and ambulatory pain with dynamic weight bearing apparatus. mRNAexpression of glial markers were studied with qRT-PCR technique on thalamic punches andlaser-microdissected nuclei. Neurochemical expressions of iba-1, CD11b/c, cathepsin S, GFAPand S100β markers were quantified using an immunohistofluorescence approach to count thenumber of immunopositive cells and surface stained by these markers. All these experimentswere done at D14 and D28 after surgery.At D14, SNL animals develop mechanical allodynia and hyperalgesia as well as ambulatory pain..For these animals, thalamic microglial cells showed signs of reactivity with the increase mRNAexpression of CTSS and CX3CR1, fractalkine receptor, well known markers involved in spinalneuronal hyperexcitability under neuropathic pain conditions. In addition, the number ofimmunopositive cells for the glial markers is decreased in SNL animals. At D28, the neuropathicpain symptoms are still present. Furthermore, thalamic microglial reactivity found at D14 withqRT-PCRm method is still present with the increased mRNA expression of fractalkine (CX3CL1),partner of CTSS/CX3CR1/CX3CL1 pathway. The decreased neurochemical expression of glialmarkers found at D14 was transient as I didn’t find this result at D28. However, thalamicastrocytic reactivity was found at D28 in SNL animals.So, this work reveal a new glial process at thalamic level in this SNL model of neuropathic pain :an early decreased expression of glial markers and then a later thalamic astrocytic reactivityconcomitant with signs of thalamic microglial reactivity. Numerous studies are required toexplore the role of such novel ambivalent glial alterations in the context of neuropathic pain.

Background Neuropathic pain (NP), defined as pain caused by a lesion or disease of the somatosensory system, affects 6.9 – 10 % of people worldwide. Pregabalin is currently recommended as a first line drug for NP in South Africa. Methods A cross-sectional retrospective descriptive medicines usage evaluation (MUE) of Pregabalin at Groote Schuur Chronic Pain clinic for the year 2017 was conducted. A MUE using a standardized data collection form was performed on 100 randomly selected folders. Data are summarized using descriptive statistics. Results The majority of cases were women (76) with a mean age of 55.9y (SD12.49). A diagnosis of NP was recorded in 58 folders and a “possible” diagnosis recorded in 7 folders. In 79 cases there was no mention of a tool/method used to diagnose NP. The most common condition diagnosed was chronic post-surgical pain with a neuropathic component (n=16), followed by NP (n=15). The most common initiating and current dose of Pregabalin was 75mg twice daily. In 56 patients, Pregabalin was prescribed in conjunction with a tricyclic antidepressant (TCA) or selective noradrenaline reuptake inhibitor (SNRI). Patient education was documented as having taken place in 76 of cases. Conclusions Based on this MUE we recommend the use of screening tools for the diagnosis of neuropathic pain, and a focus on the initiating dose of Pregabalin. The use of a standardized assessment document and the interdisciplinary team input at this clinic appears to optimize prescribing of Pregabalin in line with practice guidelines.

京都大学 / 新制・課程博士 / 博士(薬科学) / 甲第23141号 / 薬科博第140号 / 新制||薬科||15(附属図書館) / 京都大学大学院薬学研究科薬科学専攻 / (主査)教授 金子 周司, 教授 髙倉 喜信, 准教授 中川 貴之 / 学位規則第4条第1項該当 / Doctor of Pharmaceutical Sciences / Kyoto University / DFAM

La douleur neuropathique centrale est une affection fréquente dont le traitement est complexe. En raison d’un important taux de résistance aux traitements pharmacologiques, des techniques de neuromodulation ont été développées. Parmi elles, on retrouve les stimulations du cortex moteur primaire (ou gyrus précentral), invasive (i.e. stimulation électrique épidurale, eMCS) et non-invasive (i.e. stimulation magnétique transcrânienne répétitive, rTMS). Ces techniques restent limitées par différents paramètres. La rTMS a principalement été étudiée à travers des séances uniques, et son efficacité comme moyen thérapeutique au long cours reste mal connue. La eMCS souffre d’un manque de prédicteurs individuels d’efficacité suffisamment robustes pour sélectionner à bon escient les candidats à la chirurgie. Enfin, le cortex moteur primaire est une cible de découverte empirique, et d’autres cibles sont à envisager pour améliorer les résultats de ces neuromodulations corticales. Notre travail avait pour objectif l’amélioration des connaissances vis à vis de ces différentes limites. Il s’est articulé autour de 3 axes principaux :- L’étude de la rTMS en séances répétées, au long cours, comme moyen thérapeutique à part entière. - L’étude de la rTMS en séances répétées comme moyen de prédiction de la réponse antalgique à la eMCS.- Le développement de méthodes permettant la localisation fiable et reproductible du cortex pré-frontal dorsolatéral comme cible alternative de stimulation. / Central neuropathic pain is a frequent and hard to treat condition. Because of a large amount of drug-refractoriness, neuromodulation techniques have been developed. Among them, the mostly used is motor cortex stimulation, which can be both invasive (epidural motor cortex stimulation (eMCS)) and non-invasive (repetitive magnetic transcranial stimulation (rTMS)). These techniques remain limited by different problems: On one side, rTMS has been mainly studied through unique session practice and its use for pain therapy in a long-term scale remains not well understood. On the other side, eMCS suffers from a lack of predictability: A great proportion of patients present an insufficient relief, making eMCS less and less used. Finally, the motor cortex target is a chance discovery, and some other targets could be intended to improve the results. This work had the increase of knowledge about cortical stimulations as a main goal, especially about their different limitations. This work concentrated on 3 aims: - The study of chronic, repeated sessions of rTMS, used as a long-term tool for pain therapy. - The study of repeated rTMS sessions to predict eMCS.- The development of reliable tool to help to localize others cortical targets.

We are still unable to effectively suppress neuropathic pain, therefore it remains a serious problem. Ghrelin, the orexigenic hormone released by enteroendocrine stomach cells, could contribute to alleviation of the neuropathic pain by its antinociceptive effect. Previous studies have shown that ghrelin prevents development of nociceptive symptoms of neuropathic pain. The aim of our study was to determine whether chronic administration of ghrelin will affect the already fully developed neuropathic pain and differentiate its antinociceptive and analgesic effect. We used a model of chronic constriction injury of the sciatic nerve. We have proven that ghrelin suppressed the already developed thermal and mechanical hyperalgesia, so ghrelin not only prevents the development, but also suppresses the already developed nociceptive symptoms. However analgesia test showed that ghrelin did not affect the temperature preference, neither did induce the place preference. We suppose that ghrelin does not cause analgesia in neuropathic pain and its antinociceptive effect could be caused by anti- inflammatory or neuroprotective action. Key words: Ghrelin, neuropathic pain, chronic constriction injury, preference methods

(English) Modulation of synaptic transmission in dorsal horn of spinal cord plays a key role in nociceptive signalling. Recent studies have indicated a great importance of presynaptic TRPV1 receptors (transient receptor potential vanilloid) in spinal cord. These receptors act as molecular integrator of nociceptive stimulation on periphery. The way of their activation and the effect on modulation of the synaptic transmission are not clarified yet. Previous studies demonstrated the influence of many inflammatory mediators and cytokins on TRPV1 receptors. The aim of our research was to show changes in activation of presynaptic TRPV1 receptors in the spinal cord following the application of endogenous agonist N-oleoyl dopamine (OLDA) in a model of peripheral neuropathy, after incubation with cytokine TNFα and to show the effect of precursor of anandamide N-acylphosphatidylethanolamine (NAPE). In our experiments, we have recorded miniature excitatory postsynaptic currents (mEPSC) from neurons of acute spinal cord slices by the patch-clamp method. The first series of experiments tested sensitivity to application of the endogenous agonist OLDA 5 days after evoking peripheral neuropathy. The frequency of mEPSC increased significantly - to 250 % of base level after applying a low concentration of OLDA (0,2...